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General NPI Number Information
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NPI Number | 1902823727
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Entity Type | Organization
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Legal Business Name | VIRGINIA VASCULAR IMAGING LLC
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 1201 SAM PERRY BLVD # B STE 265
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-4490
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Country | US
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Telephone | 540-654-9118
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Fax | 540-654-9116
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Provider Business Mailing Address
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Address Line | 2809 EMERYWOOD PKWY STE 210
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City | RICHMOND
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State | VA
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Zip | 23294
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Country | US
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Telephone | 804-756-5130
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Fax | 804-672-6899
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL P MCDERMOTT
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Credential | MD
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Telephone | 540-654-9118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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