Provider Demographics
NPI:1659435055
Name:WOODBURN NUCLEAR MEDICINE, LTD
Entity Type:Organization
Organization Name:WOODBURN NUCLEAR MEDICINE, LTD
Other - Org Name:METRO REGION PET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:H
Authorized Official - Last Name:NORBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-698-0666
Mailing Address - Street 1:3289 WOODBURN RD
Mailing Address - Street 2:060
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-6800
Mailing Address - Country:US
Mailing Address - Phone:703-698-0666
Mailing Address - Fax:703-573-6120
Practice Address - Street 1:3289 WOODBURN RD
Practice Address - Street 2:060
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-6800
Practice Address - Country:US
Practice Address - Phone:703-698-0666
Practice Address - Fax:703-573-6120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041611261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC036364400Medicaid
DC036364400Medicaid