MEDICARE: PROGRESSIVE RADIOLOGY OF WESTMINSTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1083002281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE RADIOLOGY OF WESTMINSTER LLC

Provider Business Mailing Address
First Line	:	7799 LEESBURG PIKE
Second Line	:	SUITE 1000N
City	:	FALLS CHURCH
State	:	VA
Zip	:	22043-2408
Country	:	US
Telephone Number	:	703-667-8600
Fax Number	:	703-667-8601

Provider Business Practice Location Address
First Line	:	1011 BALTIMORE BLVD
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-7055
Country	:	US
Telephone Number	:	703-667-8600
Fax Number	:	703-667-8601

Authorized Official
Title or Position	:	CEO
Name	:	ADAM STARR
Credential	:
Telephone Number	:	703-667-8600

Provider Enumeration Date	:	12/23/2014
Last Update Date	:	12/23/2014

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