49D2246481 CLIA NUMBER - PET OF RESTON, LP

Laboratory Demographics

CLIA Number: 49D2246481

Facility Name: PET OF RESTON, LP

Facility Address:
1830 TOWN CENTER DR, SUITE 105
RESTON, VA
ZIP 20190
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Facility Phone Number: 571 601-2901

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1922024041

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	49D2246481
LAB Type	Physician Office
Facility Name	PET OF RESTON, LP
Street	1830 TOWN CENTER DR, SUITE 105
City	RESTON
State	VA
ZIP	20190
Phone	571 601-2901
CertificateType	4
CertificateEffectiveDate	12/27/2023
CertificateExpirationDate	12/26/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024