Healthcare Provider Details

I. General information

NPI: 1043228471
Provider Name (Legal Business Name): DIAGNOSTIC IMAGING ASSOCIATES P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 VIRGINIA AVE NW
NORTON VA
24273-1818
US

IV. Provider business mailing address

PO BOX 408
NORTON VA
24273
US

V. Phone/Fax

Practice location:
  • Phone: 276-679-2729
  • Fax: 276-679-0578
Mailing address:
  • Phone: 276-679-2729
  • Fax: 276-679-0578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number28258
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35510
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25573
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35177
License Number StateVA

VIII. Authorized Official

Name: KATHLEEN ANN DEPONTE
Title or Position: PRESIDENT
Credential: MD
Phone: 276-679-2729