Provider Demographics
NPI:1255356192
Name:LOUDOUN IMAGING CENTER
Entity type:Organization
Organization Name:LOUDOUN IMAGING CENTER
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 1:20905 PROFESSIONAL PLZ
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-7783
Mailing Address - Country:US
Mailing Address - Phone:571-223-0230
Mailing Address - Fax:571-223-0330
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
VAC08720Medicare ID - Type Unspecified