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General NPI Number Information
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NPI Number | 1255356192
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Entity Type | Organization
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Legal Business Name | LOUDOUN IMAGING CENTER
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 21785 FILIGREE CT SUITE 101
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City | ASHBURN
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State | VA
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Zip | 20147-6213
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Country | US
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Telephone | 703-726-1201
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Fax | 703-858-7150
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Provider Business Mailing Address
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Address Line | 20905 PROFESSIONAL PLZ SUITE 100
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City | ASHBURN
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State | VA
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Zip | 20147-7783
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Country | US
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Telephone | 571-223-0230
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Fax | 571-223-0330
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. VINCENT JAMES MASCATELLO
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Credential | M.D.
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Telephone | 703-726-1201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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