Provider Demographics
NPI:1851338222
Name:BUFORD ROAD IMAGING LLC
Entity Type:Organization
Organization Name:BUFORD ROAD IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:CARREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-267-2958
Mailing Address - Street 1:2612 BUFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3422
Mailing Address - Country:US
Mailing Address - Phone:804-864-1895
Mailing Address - Fax:804-377-3419
Practice Address - Street 1:2612 BUFORD ROAD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-3422
Practice Address - Country:US
Practice Address - Phone:804-864-1895
Practice Address - Fax:804-377-3419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1200X, 261QR0206X
VA010144531261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10144531Medicaid
VA442572OtherANTHEM BCBS
VA442572OtherANTHEM BCBS