Healthcare Provider Details

I. General information

NPI: 1215985437
Provider Name (Legal Business Name): WASHINGTON RADIOLOGY ASSOC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 WILLIAMS DR SUITE 200
FAIRFAX VA
22031-4623
US

IV. Provider business mailing address

3015 WILLIAMS DR SUITE 200
FAIRFAX VA
22031-4623
US

V. Phone/Fax

Practice location:
  • Phone: 703-641-9133
  • Fax: 703-280-5098
Mailing address:
  • Phone: 703-641-9133
  • Fax: 703-280-5098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: IAN LANDE
Title or Position: PRESIDENT
Credential: MD
Phone: 703-641-9433