Provider Demographics
NPI:1295232726
Name:RESTON RADIOLOGY CONSULTANTS INTERVENTIONAL SERVICES, LLC
Entity Type:Organization
Organization Name:RESTON RADIOLOGY CONSULTANTS INTERVENTIONAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:ATKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-726-1201
Mailing Address - Street 1:20116 ASHBROOK PL STE 150
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5087
Mailing Address - Country:US
Mailing Address - Phone:703-726-1201
Mailing Address - Fax:703-858-7150
Practice Address - Street 1:4001 FAIR RIDGE DR STE 103
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2917
Practice Address - Country:US
Practice Address - Phone:703-385-5203
Practice Address - Fax:703-385-3058
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAIR OAKS IMAGING CENTER PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty