Healthcare Provider Details

I. General information

NPI: 1700837374
Provider Name (Legal Business Name): DIAGNOSTIC RADIOLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 GRANDVIEW AVE
WATERBURY CT
06708-2507
US

IV. Provider business mailing address

134 GRANDVIEW AVE
WATERBURY CT
06708-2507
US

V. Phone/Fax

Practice location:
  • Phone: 203-756-8911
  • Fax: 203-574-0548
Mailing address:
  • Phone: 203-756-8911
  • Fax: 203-574-0548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DUNCAN BELCHER
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 203-756-8911