Healthcare Provider Details

I. General information

NPI: 1659522027
Provider Name (Legal Business Name): CARITAS VALLEY REGIONAL SUPPORT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 EAST ST RADIOLOGY DEPARTMENT
METHUEN MA
01844-4597
US

IV. Provider business mailing address

70 EAST ST ATTN: MARTHA MCDRURY
METHUEN MA
01844-4597
US

V. Phone/Fax

Practice location:
  • Phone: 978-687-0156
  • Fax: 978-685-9132
Mailing address:
  • Phone: 978-687-0156
  • Fax: 978-685-9132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MARTHA MCDRURY
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 978-687-0156