Organization
PROVIDENCE DIAGNOSTIC IMAGING, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY E. BLACKMAN M.D. (PRESIDENT)
(413) 748-9200
Entity
Organization
Contact information
Practice address
271 CAREW ST, SPRINGFIELD, MA 01104-2377
(413) 748-9200
Mailing address
271 CAREW ST, SPRINGFIELD, MA 01104-2377
(413) 748-9200
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085N0700X
Neuroradiology Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000025268
BMC HEALTHNET PLAN
MA
05
—
003126358
—
CT
01
—
102940700
US DEPARTMENT OF LABOR
—
01
—
1601748
EVERCARE
—
01
—
755228
TUFTS
MA
01
—
774327
CONNECTICARE
—
01
—
783230
AETNA/US HEALTHCARE
MA
05
—
9776559
—
MA
01
—
98133101
NETWORK HEALTH
MA
01
—
CA7920
RAILROAD MEDICARE
—
01
—
M16237
BLUE CROSS/BLUE SHIELD
MA
Enumeration date
09/03/2006
Last updated
07/01/2015
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