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NPI Code Detail

MEDICARE: WHITE MOUNTAIN RADIOLOGY INC

MEDICARE: WHITE MOUNTAIN RADIOLOGY INC
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
1261QR0200XRadiology Clinic/Center11863NH

Other Identifiers

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

General Provider Information

NPI Number : 1992752604
Entity Type Code : Organization
Provider Name (Legal Business Name) : WHITE MOUNTAIN RADIOLOGY INC
Provider Business Mailing Address
First Line : 17-17 ROUTE 208
Second Line : WHITE MOUNTAIN ROBERT GAREY CPA PC
City : FAIR LAWN
State : NJ
Zip : 07410-2820
Country : US
Telephone Number : 201-796-6400
Fax Number : 201-796-4110
Provider Business Practice Location Address
First Line : 600 SAINT JOHNSBURY RD
Second Line :
City : LITTLETON
State : NH
Zip : 03561-3442
Country : US
Telephone Number : 603-444-9577
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : GEORGE BRAFF
Credential : MD
Telephone Number : 201-796-6400
Provider Enumeration Date : 05/28/2006
Last Update Date : 07/21/2022

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