Provider Demographics
NPI:1013950112
Name:MEDICAL IMAGING OF FREDERICKSBURG, LLC
Entity Type:Organization
Organization Name:MEDICAL IMAGING OF FREDERICKSBURG, LLC
Other - Org Name:MEDICAL IMAGING OF FREDERICKSBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MIF PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONI
Authorized Official - Middle Name:FAISAL
Authorized Official - Last Name:TALUKDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-361-1000
Mailing Address - Street 1:PO BOX 830008
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0008
Mailing Address - Country:US
Mailing Address - Phone:540-741-7025
Mailing Address - Fax:
Practice Address - Street 1:1201 SAM PERRY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4490
Practice Address - Country:US
Practice Address - Phone:540-741-7025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherTRICARE
VA317546OtherMAMSI
VA292008OtherANTHEM
VA3165OtherCAREFIRST
VACJ6369Medicare PIN