MEDICARE: POSITRON EMISSION TOMOGRAPHY INSTITUTE OF HAMPTON ROADS

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	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1730144288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITRON EMISSION TOMOGRAPHY INSTITUTE OF HAMPTON ROADS

Provider Business Mailing Address
First Line	:	5357 HENNEMAN DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23513-2401
Country	:	US
Telephone Number	:	757-855-9700
Fax Number	:	757-855-9755

Provider Business Practice Location Address
First Line	:	5357 HENNEMAN DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23513-2401
Country	:	US
Telephone Number	:	757-855-9700
Fax Number	:	757-855-9755

Authorized Official
Title or Position	:	CEO
Name	:	MR. RALEIGH HAMILTON
Credential	:
Telephone Number	:	757-366-3100

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	01/12/2009

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