Healthcare Provider Details

I. General information

NPI: 1689850554
Provider Name (Legal Business Name): FAIRFAX RADIOLOGICAL CONSULTANTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3299 WOODBURN RD SUITE 110
ANNANDALE VA
22003-1275
US

IV. Provider business mailing address

2722 MERRILEE DR SUITE 230
FAIRFAX VA
22031-4400
US

V. Phone/Fax

Practice location:
  • Phone: 703-698-4483
  • Fax: 703-573-0880
Mailing address:
  • Phone: 703-698-4483
  • Fax: 703-573-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: BILL F ALLISON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 703-698-4483