Provider Demographics
NPI:1114030426
Name:PENINSULA RADIOLOGICAL ASSOCIATES LTD
Entity Type:Organization
Organization Name:PENINSULA RADIOLOGICAL ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:IRBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-612-6999
Mailing Address - Street 1:PO BOX 844724
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-4724
Mailing Address - Country:US
Mailing Address - Phone:866-759-4524
Mailing Address - Fax:757-512-5025
Practice Address - Street 1:500 J CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1929
Practice Address - Country:US
Practice Address - Phone:757-612-9999
Practice Address - Fax:757-512-5025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA324485OtherANTHEM
NC89015F9Medicaid
NCDA6755Medicare PIN
NC89015F9Medicaid
VA324485OtherANTHEM
NC2320819Medicare PIN