ML20214M456
| ML20214M456 | |
| Person / Time | |
|---|---|
| Site: | 07002199 |
| Issue date: | 01/29/1986 |
| From: | Goss A VETERANS ADMIN. MEDICAL CENTER, WASHINGTON, DC |
| To: | Glenn J, Johansen J NRC, NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I) |
| Shared Package | |
| ML20213D562 | List: |
| References | |
| 105019, 688-115, NUDOCS 8609110122 | |
| Download: ML20214M456 (4) | |
Text
\\
.p
{
q 50 Irving Street. NW.
Medical Center Washington D.C. 20422 s
j 070-da/97 Veterans Administration in Reply Refer To:
688/115 January 29, 1986 Dr. John E.
Glenn, Section Chief Licensing Section US Nuclear Regulatory Commission Region I631 Park Avenue King of Prussia, PA 19406 Attention:
Jenny M. Johansen Mail Control No.
10429.3 THRU:
Dr. James J.
Smith, Director (115)
~,
Nuclear Medicine Service,
Reference:
License No. SNM-1605 SUBJ:
Renewal of Pacemaker License 1.
We wish to renew our special nuclear material license SNM-1605 which expires February 28, 1986.
2.
The information necessary for renewal of our license (arranged in accordance with enclosure 1 of your expiration notice) is enclosed.
s ALLAN S.
GOSS Acting Medical Center Director
/
l 105019
.g 860911012p 860929 REG 1 LIC70 PDR O, $' l~'
n SNM-160S c -- Oh ~r s.
GI "0tTiCW.EDE COM" "*w FEB 041986
" America is #1-Thanks to our Veterans" 1
s O
O License Renewal Information A.
License No:
SNM-1605 i
B.
Mailing Address:
Veterans Administration Medical Center Radiation Safety Office (115) 50 Irving St.
"S.W."
Washington, D.C.
20422 l
C.
The Number of pacemakers to be authorized.
1.
Manufacturer:
Coratomic Model:
C-101-P Number:
4 i
2.
Manufacturer:
Coratomic i
Model:
C-101 Number 1 (Implanted in patient) 1 l
O O
D.
Physicians to be added to License:
Name:
Benjamin Irving Lee, M.D.
Office Address:
VA Medical Center Cardiology Section (151D) 50 Irving St.
N.W.
Wash'ington, D.C.
20422 (151D)
Phone Number:
745-8428 Licensure:
DDI, Lithium 5 years O implants Certification:
Dipicmate of the National Board of Medical Examiners, 1978.
Diplomate, American Board of Internal Medicine, 1980.
Subspecialty of Cardiovascular Medicine, 1983 i
Position: Attending Cardiologist Physician's Name:
Andrew Ira Cohen, M.D.
Office Address:
VA Medical Center Cardiology Section (151D) 50 Irving St.
N.W.
Washington, D.C.
20422 (151D) l Phone Number:
745-8428 l
l Licensure:
MD Certification:
Certified Internal Medicine, Certified Cardiology Position:
Staff Cardiologist Pacemakers:
6 years 3 implants Physician's Name:
Marc H. Wish, M.D.
Office Address:
VA Medical Center Cardiology Section (151D) 1 50 Irving St.
N.W.
Washington, D.C.
20422 (151D)
Phone Number:
745-8428 Licensure:
MD l
Certification: National Board of Medical Internal Medicine Position:
Staff Cardiologist Pacemakers:
3 years 30 implants l
.b O
O Protocol Hume.n Implantation Protocol for the Coratomic C-101-P Radioisotope Powered cardiac pacer, Dated March 2, 1983.
?
Physicians Statement I have read, and agree to comply with the implant Protocol naied above.
7
-E t/23fff m
Be j in rv' gdee,
.D.
Date p ty l L3,jd' i
,v.o An rew Ira, Cohen, M.D.
Date I
k k b}N(
13f(,
t Marc H. Wish, M.D.
Date l
l
. - -. - - -