Provider Demographics
NPI:1700831104
Name:2D DIAGNOSTIC OF VIRGINIA, INC
Entity Type:Organization
Organization Name:2D DIAGNOSTIC OF VIRGINIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:ANA
Authorized Official - Last Name:POPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-354-2455
Mailing Address - Street 1:103 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-2023
Mailing Address - Country:US
Mailing Address - Phone:877-354-2455
Mailing Address - Fax:866-328-8732
Practice Address - Street 1:1604 DENHAM RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-3904
Practice Address - Country:US
Practice Address - Phone:877-354-2455
Practice Address - Fax:866-328-8732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238521174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA184222OtherANTHEM PPO PROVIDER NUMBE
VA10226775Medicaid
VA184222OtherANTHEM PPO PROVIDER NUMBE