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General NPI Number Information
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NPI Number | 1609111525
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Entity Type | Organization
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Legal Business Name | WAHOO RADIOLOGY, PLLC
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Dates
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Enumeration Date | 12/04/2012
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Last Update Date | 03/10/2015
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Provider Practice Location Address
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Address Line | 101 HARRIS RD
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City | KILMARNOCK
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State | VA
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Zip | 22482-3880
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Country | US
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Telephone | 804-435-8539
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Fax |
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Provider Business Mailing Address
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Address Line | 3332 NEWLAND CT
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City | TOANO
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State | VA
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Zip | 23168-9373
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Country | US
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Telephone | 804-435-8539
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. MATTHEW C ALLISON
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Credential | M.D.
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Telephone | 804-435-8539
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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 | 2007-01705
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License Number State | NC
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