Healthcare Provider Details

I. General information

NPI: 1538110846
Provider Name (Legal Business Name): BEVERLY RADIOLOGY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 HERRICK ST RADIOLOGY DEPARTMENT
BEVERLY MA
01915-1776
US

IV. Provider business mailing address

85 HERRICK ST RADIOLOGY DEPARTMENT
BEVERLY MA
01915-1776
US

V. Phone/Fax

Practice location:
  • Phone: 978-927-6385
  • Fax: 978-927-3534
Mailing address:
  • Phone: 978-927-6385
  • Fax: 978-927-3534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: AUGUSTINE O'KEEFFE
Title or Position: PRESIDENT
Credential: MD
Phone: 978-927-6385