Healthcare Provider Details

I. General information

NPI: 1841476744
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: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24801 PINEBROOK RD STE 120
CHANTILLY VA
20152-4112
US

IV. Provider business mailing address

2722 MERRILEE DR STE 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: 703-573-0888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

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