Provider Demographics
NPI:1356494579
Name:BONE DENSITOMETRY CENTER
Entity Type:Organization
Organization Name:BONE DENSITOMETRY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROCHMIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-573-3301
Mailing Address - Street 1:3027 JAVIER RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4607
Mailing Address - Country:US
Mailing Address - Phone:703-573-3301
Mailing Address - Fax:703-573-7767
Practice Address - Street 1:3027 JAVIER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4607
Practice Address - Country:US
Practice Address - Phone:703-573-3301
Practice Address - Fax:703-573-7767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101020441261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA052512OtherANTHEM
VA=========OtherCIGNA
VA052512OtherANTHEM
VA068510Medicare ID - Type UnspecifiedMEDICARE