Organization
BISTATE DIAGNOSTIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. REYNALDO DUIGUAN JOSE MD (PARTNER OWNER)
(276) 322-4520
Entity
Organization
Contact information
Practice address
RR2 BOX 26 RIVERBEND EST, BLUEFIELD, VA 24605-0784
(276) 322-4520
(276) 322-4520
Mailing address
PO BOX 784, BLUEFIELD, VA 24605-0784
(276) 322-4520
(276) 322-4520
Taxonomy
Speciality
Code
Description
License number
State
2471S1302X
Sonography Radiologic Technologist
Primary
0101034219
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010269989
—
VA
Enumeration date
09/25/2006
Last updated
09/12/2008
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