MEDICARE: RADIOLOGY ASSOCIATES OF PLYMOUTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician		NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225017015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIOLOGY ASSOCIATES OF PLYMOUTH

Provider Business Mailing Address
First Line	:	PO BOX 9132
Second Line	:
City	:	BROOKLINE
State	:	MA
Zip	:	02446-9132
Country	:	US
Telephone Number	:	800-927-0002
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 HAMBURG TPKE
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-2110
Country	:	US
Telephone Number	:	973-904-0404
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	RONALD GOLDBERG
Credential	:	MD
Telephone Number	:	800-927-0002

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	08/22/2020

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