MEDICARE: ULTRA IMAGING INC

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	2085B0100X	Body Imaging Physician

General Provider Information

NPI Number	:	1811583560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTRA IMAGING INC

Provider Business Mailing Address
First Line	:	5633 ALBRIGHT DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-6725
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5633 ALBRIGHT DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-6725
Country	:	US
Telephone Number	:	757-470-1208
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	IRENE STEPHANITSIS
Credential	:	ARDMS
Telephone Number	:	757-470-1208

Provider Enumeration Date	:	12/16/2020
Last Update Date	:	01/29/2021

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