Basic Information
| Provider Information | |||||||||
| NPI: | 1891832184 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RADER | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | B. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5544 GREENWICH RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234626563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032463435 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5544 GREENWICH RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234626563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574660089 | ||||||||
| FaxNumber: | 7574668017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 02/07/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085P0229X | 0102202327 | VA | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0202X | DOS-879 | HI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 0102202327 | VA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 10055213 | 01 | VA | SENTARA | OTHER | 10055213 | 01 | VA | OPTIMA | OTHER | P00815457 | 01 | VA | RR MEDICARE | OTHER | 139178 | 01 | VA | BCBS | OTHER | 1891832184 | 05 | VA | MEDICAID | 5917289 | 05 | NC | MEDICAID |