Provider Demographics
NPI:1730144288
Name:POSITRON EMISSION TOMOGRAPHY INSTITUTE OF HAMPTON ROADS
Entity Type:Organization
Organization Name:POSITRON EMISSION TOMOGRAPHY INSTITUTE OF HAMPTON ROADS
Other - Org Name:PET INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RALEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-366-3100
Mailing Address - Street 1:5357 HENNEMAN DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-2401
Mailing Address - Country:US
Mailing Address - Phone:757-855-9700
Mailing Address - Fax:757-855-9755
Practice Address - Street 1:5357 HENNEMAN DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-2401
Practice Address - Country:US
Practice Address - Phone:757-855-9700
Practice Address - Fax:757-855-9755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAFVN001Medicare PIN