MEDICARE: VIRGINIA BEACH RADIOLOGY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487605358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIA BEACH RADIOLOGY PC

Provider Business Mailing Address
First Line	:	1821 OLD DONATION PKWY
Second Line	:	SUITE 7
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3033
Country	:	US
Telephone Number	:	757-481-1175
Fax Number	:	757-481-5081

Provider Business Practice Location Address
First Line	:	1821 OLD DONATION PKWY
Second Line	:	SUITE 7
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3033
Country	:	US
Telephone Number	:	757-481-1175
Fax Number	:	757-481-5081

Authorized Official
Title or Position	:	OWNER PHYSICIAN
Name	:	JACK LOWDON
Credential	:	MD
Telephone Number	:	757-481-1175

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	11/01/2007

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