Healthcare Provider Details

I. General information

NPI: 1508838624
Provider Name (Legal Business Name): POTOMAC RADIOLOGY & IMAGING ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 OPITZ BLVD
WOODBRIDGE VA
22191-3311
US

IV. Provider business mailing address

1201 SEVEN LOCKS RD SUITE 200
ROCKVILLE MD
20854-2931
US

V. Phone/Fax

Practice location:
  • Phone: 703-670-1561
  • Fax: 703-670-4961
Mailing address:
  • Phone: 301-652-5771
  • Fax: 301-652-6332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: PALANI RATHINASAMY
Title or Position: PRESIDENT
Credential: MD
Phone: 703-670-1561