Provider Demographics
NPI:1013235910
Name:WASHINGTON RADIOLOGY ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:WASHINGTON RADIOLOGY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-641-9133
Mailing Address - Street 1:3015 WILLIAMS DR
Mailing Address - Street 2:STE 200
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4623
Mailing Address - Country:US
Mailing Address - Phone:703-641-9133
Mailing Address - Fax:703-280-5098
Practice Address - Street 1:12505 PARK POTOMAC AVE
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-6801
Practice Address - Country:US
Practice Address - Phone:703-641-9133
Practice Address - Fax:703-280-5098
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON RADIOLOGY ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-17
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC409885Medicare PIN