Provider Demographics
NPI:1720535958
Name:RESTON ENDOSCOPY CENTER
Entity Type:Organization
Organization Name:RESTON ENDOSCOPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:M
Authorized Official - Last Name:AXELRAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-766-2650
Mailing Address - Street 1:1939 ROLAND CLARKE PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-1443
Mailing Address - Country:US
Mailing Address - Phone:703-766-2650
Mailing Address - Fax:
Practice Address - Street 1:1939 ROLAND CLARKE PL
Practice Address - Street 2:SUITE 200
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1443
Practice Address - Country:US
Practice Address - Phone:703-766-2650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy