=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568765907
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED ULTRASOUND IMAGING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2010
-----------------------------------------------------
Last Update Date | 12/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6811 INDIAN RUN CT
-----------------------------------------------------
City | ANNANDALE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22003-5937
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-477-0167
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6811 INDIAN RUN CT
-----------------------------------------------------
City | ANNANDALE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22003-5937
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-477-0167
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWMER
-----------------------------------------------------
Name | MRS. AZEB KASSA
-----------------------------------------------------
Credential | RDCS
-----------------------------------------------------
Telephone | 703-477-0167
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085U0001X
-----------------------------------------------------
Taxonomy Name | Diagnostic Ultrasound Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------