Provider Demographics
NPI:1487605358
Name:VIRGINIA BEACH RADIOLOGY PC
Entity type:Organization
Organization Name:VIRGINIA BEACH RADIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-481-1175
Mailing Address - Street 1:1821 OLD DONATION PKWY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3033
Mailing Address - Country:US
Mailing Address - Phone:757-481-1175
Mailing Address - Fax:757-481-5081
Practice Address - Street 1:1821 OLD DONATION PKWY
Practice Address - Street 2:SUITE 7
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3033
Practice Address - Country:US
Practice Address - Phone:757-481-1175
Practice Address - Fax:757-481-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7263295Medicaid
VA7263295Medicaid