Provider Demographics
NPI:1376965236
Name:VIRTUAL RADIOLOGY INC
Entity Type:Organization
Organization Name:VIRTUAL RADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RADIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ABNER
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:727-586-0545
Mailing Address - Street 1:2520 W BAY DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-1935
Mailing Address - Country:US
Mailing Address - Phone:727-586-0545
Mailing Address - Fax:727-586-0547
Practice Address - Street 1:2520 W BAY DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-1935
Practice Address - Country:US
Practice Address - Phone:727-586-0545
Practice Address - Fax:727-586-0547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56269261QR0200X, 261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL1211692OtherDEA
FL255802Medicare Oscar/Certification