Healthcare Provider Details

I. General information

NPI: 1508451709
Provider Name (Legal Business Name): DOMINION RADIOLOGY ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 BATTLEFIELD BLVD N
CHESAPEAKE VA
23320-4941
US

IV. Provider business mailing address

6600 W BROAD ST STE 200
RICHMOND VA
23230-1709
US

V. Phone/Fax

Practice location:
  • Phone: 757-777-3940
  • Fax: 540-361-7010
Mailing address:
  • Phone: 540-361-1000
  • Fax: 540-361-7010

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: DR. DAVID COHEN
Title or Position: MEMBER
Credential: MD
Phone: 757-448-7174