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Organization

UVA OUTPATIENT IMAGING CENTREVILLE LLC

Active
Other names
UVA Health Outpatient Imaging Centreville, UVA Outpatient Imaging Centreville
Organization subpart
No

Provider details

NPI number
Authorized official
MR. CHARLES D CODER (CFO)
(804) 835-2069
Entity
Organization

Contact information

Practice address
6208 MULTIPLEX DRIVE, SUITE 100, CENTREVILLE, VA 20121-5324
(703) 825-2244
(703) 830-3610
Mailing address
PO BOX 931912, ATLANTA, GA 31193-1912
(866) 659-1211
(336) 774-1751

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
010062381
VA
01
185293
BC
VA
01
7217512
AETNA
01
J428
CAREFIRST
01
P00450165
MEDICARE RAILROAD
Enumeration date
05/03/2006
Last updated
09/26/2023
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