Provider Demographics
NPI:1427034776
Name:PAREDES INSTITUTE FOR WOMEN'S IMAGING PC
Entity type:Organization
Organization Name:PAREDES INSTITUTE FOR WOMEN'S IMAGING PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PROVIDER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAW DE PAREDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-523-2303
Mailing Address - Street 1:4480 COX RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6751
Mailing Address - Country:US
Mailing Address - Phone:804-523-2303
Mailing Address - Fax:804-523-3210
Practice Address - Street 1:4480 COX RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6751
Practice Address - Country:US
Practice Address - Phone:804-523-2303
Practice Address - Fax:804-523-3210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C09S20Medicare ID - Type Unspecified