Provider Demographics
NPI:1902821853
Name:RESTON RADIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:RESTON RADIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MASCATELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-726-1201
Mailing Address - Street 1:1850 TOWN CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3219
Mailing Address - Country:US
Mailing Address - Phone:703-689-9008
Mailing Address - Fax:703-689-9122
Practice Address - Street 1:21785 FILIGREE CT
Practice Address - Street 2:SUITE 101
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6213
Practice Address - Country:US
Practice Address - Phone:703-726-1201
Practice Address - Fax:703-858-7150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA476171Medicare ID - Type Unspecified