Healthcare Provider Details

I. General information

NPI: 1659435055
Provider Name (Legal Business Name): WOODBURN NUCLEAR MEDICINE, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3289 WOODBURN RD 060
ANNANDALE VA
22003-6800
US

IV. Provider business mailing address

3289 WOODBURN RD STE 60
ANNANDALE VA
22003-7337
US

V. Phone/Fax

Practice location:
  • Phone: 703-698-0666
  • Fax: 703-573-6120
Mailing address:
  • Phone: 703-698-0666
  • Fax: 703-573-6120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number0101041611
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRACY PRINCE
Title or Position: DIRECTOR
Credential:
Phone: 480-594-3884