Provider Demographics
NPI:1396915237
Name:ASTOR, WILLIAM MATTHEW (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MATTHEW
Last Name:ASTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2722 MERRILEE DR
Mailing Address - Street 2:STE 230
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4420
Mailing Address - Country:US
Mailing Address - Phone:703-698-4444
Mailing Address - Fax:703-204-0116
Practice Address - Street 1:2722 MERRILEE DR
Practice Address - Street 2:STE 230
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4420
Practice Address - Country:US
Practice Address - Phone:703-698-4444
Practice Address - Fax:703-204-0116
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012509282085N0700X, 2085R0202X
MDD00876332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0122OtherBLUECROSS BLUESHIELD
WV3810020391Medicaid
VA0122OtherBLUECROSS BLUESHIELD
VAVV6003AMedicare PIN