Healthcare Provider Details

I. General information

NPI: 1295949220
Provider Name (Legal Business Name): HOUSTON MICHAEL AARON II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 J CLYDE MORRIS BLVD RIVERSIDE REGIONAL MEDICAL CENTER
NEWPORT NEWS VA
23601-1929
US

IV. Provider business mailing address

P O BOX 12087 PENINSULA RADIOLOGICAL ASSOCIATES
NEWPORT NEWS VA
23612-2087
US

V. Phone/Fax

Practice location:
  • Phone: 757-612-6999
  • Fax: 757-750-3664
Mailing address:
  • Phone: 757-867-6101
  • Fax: 757-750-3664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberEMC0005197
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberM6990
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101265992
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number21276
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: