Healthcare Provider Details

I. General information

NPI: 1619110475
Provider Name (Legal Business Name): TRICITY IMAGING & DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 04/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 S SYCAMORE ST
PETERSBURG VA
23803-5814
US

IV. Provider business mailing address

603 S SYCAMORE ST
PETERSBURG VA
23803-5814
US

V. Phone/Fax

Practice location:
  • Phone: 804-901-1087
  • Fax: 540-854-5800
Mailing address:
  • Phone: 804-901-1087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License NumberS287380
License Number StateVA

VIII. Authorized Official

Name: TEHSIN ANJUM
Title or Position: OWNER
Credential:
Phone: 804-901-1087