Healthcare Provider Details

I. General information

NPI: 1982638177
Provider Name (Legal Business Name): WILLIAM G HARSHAW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2722 MERRILEE DR SUITE 230
FAIRFAX VA
22031-4400
US

IV. Provider business mailing address

PO BOX 3650
FAIRFAX VA
22038-3650
US

V. Phone/Fax

Practice location:
  • Phone: 703-698-0056
  • Fax: 703-573-0880
Mailing address:
  • Phone: 703-698-0056
  • Fax: 703-573-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number0101015932
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number0101015932
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number0101015932
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number0101015932
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101015932
License Number StateVA
# 6
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number0101015932
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number0101015932
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: