Provider Demographics
NPI:1295026086
Name:IMAGE MEDICAL LLC
Entity Type:Organization
Organization Name:IMAGE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRZAD
Authorized Official - Middle Name:ALEXANDROS
Authorized Official - Last Name:RAHIMI
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:301-367-1666
Mailing Address - Street 1:P.O. BOX 231059
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120
Mailing Address - Country:US
Mailing Address - Phone:301-367-1666
Mailing Address - Fax:
Practice Address - Street 1:14701 LEE HWY
Practice Address - Street 2:SUITE 303
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2137
Practice Address - Country:US
Practice Address - Phone:301-367-1666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty