Provider Demographics
NPI:1982664470
Name:MID-ATLANTIC RADIATION ONCOLOGY-RESTON PLC
Entity Type:Organization
Organization Name:MID-ATLANTIC RADIATION ONCOLOGY-RESTON PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGERIAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JANETE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-266-8717
Mailing Address - Street 1:5711 STAPLES MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228
Mailing Address - Country:US
Mailing Address - Phone:804-266-8717
Mailing Address - Fax:804-266-5677
Practice Address - Street 1:1850 TOWN CENTER PARKWAY
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190
Practice Address - Country:US
Practice Address - Phone:703-689-9330
Practice Address - Fax:703-689-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01267Medicare ID - Type Unspecified