Healthcare Provider Details

I. General information

NPI: 1255356192
Provider Name (Legal Business Name): LOUDOUN IMAGING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21785 FILIGREE CT SUITE 101
ASHBURN VA
20147-6213
US

IV. Provider business mailing address

20905 PROFESSIONAL PLZ SUITE 100
ASHBURN VA
20147-7783
US

V. Phone/Fax

Practice location:
  • Phone: 703-726-1201
  • Fax: 703-858-7150
Mailing address:
  • Phone: 571-223-0230
  • Fax: 571-223-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. VINCENT JAMES MASCATELLO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 703-726-1201