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General NPI Number Information
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NPI Number | 1295026086
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Entity Type | Organization
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Legal Business Name | IMAGE MEDICAL LLC
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Dates
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Enumeration Date | 04/27/2011
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 14701 LEE HWY SUITE 303
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City | CENTREVILLE
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State | VA
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Zip | 20121-2137
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Country | US
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Telephone | 301-367-1666
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 231059
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City | CENTREVILLE
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State | VA
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Zip | 20120
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Country | US
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Telephone | 301-367-1666
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | DR. SHIRZAD ALEXANDROS RAHIMI
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Credential | CSA
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Telephone | 301-367-1666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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