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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