MEDICARE: VALLEY RADIOLOGISTS, P.A.

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	CB4628	OTHER		RAILROAD MEDICARE

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
2	303648	OTHER		MATHEW THORTON
3	VALL00003648	OTHER	VT	BCBS VT
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	303648	OTHER	NH	BCBS NH

General Provider Information

NPI Number	:	1720023914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY RADIOLOGISTS, P.A.

Provider Business Mailing Address
First Line	:	243 ELM ST
Second Line	:
City	:	CLAREMONT
State	:	NH
Zip	:	03743-4921
Country	:	US
Telephone Number	:	603-826-2911
Fax Number	:

Provider Business Practice Location Address
First Line	:	243 ELM ST
Second Line	:
City	:	CLAREMONT
State	:	NH
Zip	:	03743-4921
Country	:	US
Telephone Number	:	603-826-2911
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID HASEMAN
Credential	:
Telephone Number	:	802-674-6711

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	07/17/2007

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Directions to “VALLEY RADIOLOGISTS, P.A. ” Practice Location

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