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General NPI Number Information
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NPI Number | 1811583560
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Entity Type | Organization
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Legal Business Name | ULTRA IMAGING INC
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Dates
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Enumeration Date | 12/16/2020
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Last Update Date | 01/29/2021
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Provider Practice Location Address
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Address Line | 5633 ALBRIGHT DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-6725
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Country | US
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Telephone | 757-470-1208
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Fax |
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Provider Business Mailing Address
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Address Line | 5633 ALBRIGHT DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-6725
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | IRENE STEPHANITSIS
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Credential | ARDMS
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Telephone | 757-470-1208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State |
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