Healthcare Provider Details

I. General information

NPI: 1376081406
Provider Name (Legal Business Name): NORTHERN VIRGINIA IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 06/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 PIDGEON HILL DR
STERLING VA
20165-6173
US

IV. Provider business mailing address

7801 OLD BRANCH AVE SUITE 300
CLINTON MD
20735-1608
US

V. Phone/Fax

Practice location:
  • Phone: 703-450-5800
  • Fax: 703-450-0495
Mailing address:
  • Phone: 301-856-6718
  • Fax: 301-856-6722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberB194224
License Number StateVA

VIII. Authorized Official

Name: JOSEPH P. FINIZIO
Title or Position: MEMBER
Credential: MD
Phone: 301-856-6718