Healthcare Provider Details

I. General information

NPI: 1164054276
Provider Name (Legal Business Name): MEDICAL CENTER RADIOLOGISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

5544 GREENWICH RD
VIRGINIA BEACH VA
23462-6563
US

V. Phone/Fax

Practice location:
  • Phone: 757-338-3231
  • Fax:
Mailing address:
  • Phone: 757-466-0089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: RICHARD J THOMAS
Title or Position: PRESIDENT
Credential: MD
Phone: 757-466-0089