Provider Demographics
NPI:1386778074
Name:MONUMENT RADIOLOGY PC
Entity type:Organization
Organization Name:MONUMENT RADIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DIRCK
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRENDLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-288-8321
Mailing Address - Street 1:7231 FOREST AVE
Mailing Address - Street 2:#102
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226
Mailing Address - Country:US
Mailing Address - Phone:804-288-8321
Mailing Address - Fax:804-285-3245
Practice Address - Street 1:7231 FOREST AVE
Practice Address - Street 2:#102
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226
Practice Address - Country:US
Practice Address - Phone:804-288-8321
Practice Address - Fax:804-285-3245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty