Provider Demographics
NPI:1821108150
Name:RADIOLOGY SPECIALISTS PC
Entity Type:Organization
Organization Name:RADIOLOGY SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:HECHT-LEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-671-1144
Mailing Address - Street 1:4668 PEMBROKE BLVD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6423
Mailing Address - Country:US
Mailing Address - Phone:757-671-1144
Mailing Address - Fax:757-965-4162
Practice Address - Street 1:4668 PEMBROKE BLVD
Practice Address - Street 2:SUITE 117
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6423
Practice Address - Country:US
Practice Address - Phone:757-671-1144
Practice Address - Fax:757-671-7299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA185902OtherANTHEM BC/BS OF VA
VA7962738OtherAETNA GROUP NUMBER
VA7962738OtherAETNA GROUP NUMBER