Provider Demographics
NPI:1467885228
Name:FAIRFAX RADIOLOGICAL CONSULTANTS PC
Entity Type:Organization
Organization Name:FAIRFAX RADIOLOGICAL CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-698-4444
Mailing Address - Street 1:2722 MERRILEE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4400
Mailing Address - Country:US
Mailing Address - Phone:703-698-4444
Mailing Address - Fax:703-204-0116
Practice Address - Street 1:3801 UNIVERSITY DR
Practice Address - Street 2:STE 120
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2503
Practice Address - Country:US
Practice Address - Phone:703-698-4467
Practice Address - Fax:703-788-8422
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAIRFAX RADIOLOGICAL CONSULTANTS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-15
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
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