Healthcare Provider Details

I. General information

NPI: 1851348106
Provider Name (Legal Business Name): CARITAS CHRISTI DIAGNOSTIC SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CAMBRIDGE STREET C/O CARITAS ST. ELIZABETH'S MEDICAL CENTER
BRIGHTON MA
02135-2907
US

IV. Provider business mailing address

736 CAMBRIDGE STREET C/O CARITAS ST. ELIZABETH'S MEDICAL CENTER
BRIGHTON MA
02135-2907
US

V. Phone/Fax

Practice location:
  • Phone: 617-562-5491
  • Fax: 617-562-5481
Mailing address:
  • Phone: 617-562-5491
  • Fax: 617-562-5481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471V0106X
TaxonomyVascular-Interventional Technology Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT M. HADDAD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 617-789-2500