Healthcare Provider Details

I. General information

NPI: 1013935709
Provider Name (Legal Business Name): ASSOCIATION OF ALEXANDRIA RADIOLOGISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 SEMINARY RD
ALEXANDRIA VA
22304-1535
US

IV. Provider business mailing address

8001 FORBES PL SUITE 103
SPRINGFIELD VA
22151-2208
US

V. Phone/Fax

Practice location:
  • Phone: 703-504-3000
  • Fax: 703-504-7616
Mailing address:
  • Phone: 703-824-3210
  • Fax: 703-321-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBIN JERVIS
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 703-824-3215