1457310765 NPI number — ASSOCIATED RADIOLOGIST,PA

Table of content: (NPI 1457310765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457310765 NPI number — ASSOCIATED RADIOLOGIST,PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATED RADIOLOGIST,PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457310765
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 291
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03051-0291
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-883-4636
Provider Business Mailing Address Fax Number:
603-883-6854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 TSIENNETO RD
Provider Second Line Business Practice Location Address:
DERRY IMAGING
Provider Business Practice Location Address City Name:
DERRY
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03038-0291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-883-4636
Provider Business Practice Location Address Fax Number:
603-883-6854
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEAULIEU
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
603-883-4636

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NH3590 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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