Provider Demographics
NPI:1952465064
Name:HALIFAX RADIOLOGICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:HALIFAX RADIOLOGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:
Authorized Official - Last Name:SAN PEDRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-517-3686
Mailing Address - Street 1:2204 WILBORN AVE
Mailing Address - Street 2:RADIOLOGY DEPARTMENT
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-1645
Mailing Address - Country:US
Mailing Address - Phone:434-517-3187
Mailing Address - Fax:434-517-3686
Practice Address - Street 1:2204 WILBORN AVE
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-1645
Practice Address - Country:US
Practice Address - Phone:434-517-3187
Practice Address - Fax:434-517-3686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027902174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty