Healthcare Provider Details

I. General information

NPI: 1629000179
Provider Name (Legal Business Name): NORTHERN VIRGINIA MRI, JOINT VENTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 S CARLIN SPRINGS RD SUITE 102
ARLINGTON VA
22204-1064
US

IV. Provider business mailing address

611 S CARLIN SPRINGS RD SUITE 102
ARLINGTON VA
22204-1064
US

V. Phone/Fax

Practice location:
  • Phone: 703-931-8990
  • Fax: 703-931-5201
Mailing address:
  • Phone: 703-931-8990
  • Fax: 703-931-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number22 028788400
License Number StateVA

VIII. Authorized Official

Name: MS. DEBORAH A DEATON
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 703-931-8990