Healthcare Provider Details

I. General information

NPI: 1972838993
Provider Name (Legal Business Name): INOVA RESTON MRI CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ELDEN ST SUITE 16M
HERNDON VA
20170-4873
US

IV. Provider business mailing address

2722 MERRILEE DR STE 230
FAIRFAX VA
22031-4400
US

V. Phone/Fax

Practice location:
  • Phone: 703-481-9400
  • Fax: 703-481-9408
Mailing address:
  • Phone: 703-698-4444
  • Fax: 703-698-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICARDO TALENTO
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 571-472-8717