Provider Demographics
NPI:1528627734
Name:RADIOLOGY INSTITUTE
Entity type:Organization
Organization Name:RADIOLOGY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KORANGY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-269-0704
Mailing Address - Street 1:12731 MARBLESTONE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-8334
Mailing Address - Country:US
Mailing Address - Phone:703-269-0704
Mailing Address - Fax:
Practice Address - Street 1:12731 MARBLESTONE DR STE 105
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8334
Practice Address - Country:US
Practice Address - Phone:703-269-0704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-11
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1770679466OtherNPI OF PROVIDER
VA1528627734OtherAETNA, CIGNA, UNITED, COMMERCIAL, MEDICAID VA, ANTHEM