Organization
PENTUCKET MEDICAL RADIOLOGY
Active
Parent organization
PENTUCKET MEDICAL ASSOCIATES, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PENTUCKET MEDICAL ASSOCIATES, LLC
Authorized official
DR. THOMAS L. FAZIO MD (PRESIDENT)
(978) 521-3200
Entity
Organization
Contact information
Practice address
1 PARKWAY, HAVERHILL, MA 01830-6278
(978) 521-3260
(978) 469-5378
Mailing address
1 PARKWAY, HAVERHILL, MA 01830-6278
(978) 521-3260
(978) 469-5378
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
09570
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039516
NEIGHBORHOOD HEALTH PLAN
MA
Enumeration date
04/02/2008
Last updated
05/16/2011
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