Healthcare Provider Details

I. General information

NPI: 1982995296
Provider Name (Legal Business Name): GRAFTON CT IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 GEORGE WASHINGTON MEM HWY STE A
GRAFTON VA
23692-2619
US

IV. Provider business mailing address

4030 GEORGE WASHINGTON MEM HWY STE A
GRAFTON VA
23692-2619
US

V. Phone/Fax

Practice location:
  • Phone: 757-898-1598
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number35091
License Number StateVA

VIII. Authorized Official

Name: SCOTT GOLRICH
Title or Position: PRESIDENT
Credential:
Phone: 757-898-1598