Healthcare Provider Details

I. General information

NPI: 1043666415
Provider Name (Legal Business Name): NORTHPOINT DIAGNOSTIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 NORTHPOINT PKWY SUITE P4
WEST PALM BEACH FL
33407-1973
US

IV. Provider business mailing address

801 NORTHPOINT PKWY SUITE P4
WEST PALM BEACH FL
33407-1973
US

V. Phone/Fax

Practice location:
  • Phone: 561-807-8552
  • Fax: 561-807-8553
Mailing address:
  • Phone: 561-807-8552
  • Fax: 561-807-8553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME116999
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME31479
License Number StateFL

VIII. Authorized Official

Name: TAMMY CARPENTER
Title or Position: OFFICE MANAGER
Credential:
Phone: 561-807-8552