Healthcare Provider Details

I. General information

NPI: 1528090131
Provider Name (Legal Business Name): WACHUSETT RADIOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 GREEN ST RADIOLOGY DEPARTMENT
GARDNER MA
01440-1336
US

IV. Provider business mailing address

10 LITTLE BROOK RD
WEST WAREHAM MA
02576-1222
US

V. Phone/Fax

Practice location:
  • Phone: 997-863-0623
  • Fax: 978-630-6353
Mailing address:
  • Phone: 800-841-5200
  • Fax: 508-273-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA CHEN
Title or Position: PRESIDENT
Credential: MD
Phone: 978-632-7383