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General NPI Number Information
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NPI Number | 1689850554
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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 | 09/20/2010
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Provider Practice Location Address
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Address Line | 3299 WOODBURN RD SUITE 110
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City | ANNANDALE
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State | VA
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Zip | 22003-1275
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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 | 2722 MERRILEE DR SUITE 230
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City | FAIRFAX
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State | VA
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Zip | 22031-4400
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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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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 | 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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