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General NPI Number Information
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NPI Number | 1417133398
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Entity Type | Organization
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Legal Business Name | FAIRFAX RADIOLOGICAL CONSULTANTS PC
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 01/12/2011
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Provider Practice Location Address
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Address Line | 115 PARK ST SE STE 203
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City | VIENNA
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State | VA
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Zip | 22180-4653
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Country | US
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Telephone | 703-698-4483
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Fax | 703-573-0880
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Provider Business Mailing Address
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Address Line | PO BOX 3650
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City | MERRIFIELD
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State | VA
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Zip | 22116-3650
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Country | US
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Telephone | 703-698-4444
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Fax | 703-573-0880
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BILL F ALLISON
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Credential |
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Telephone | 703-698-4483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number | 221597
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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