Healthcare Provider Details

I. General information

NPI: 1043298821
Provider Name (Legal Business Name): NEWTON WELLESLEY RADIOLOGY ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 WASHINGTON ST NEWTON WELLESLEY RADIOLOGY ASSOCIATES
NEWTON MA
02462-1607
US

IV. Provider business mailing address

PO BOX 417400 NEWTON WELLESLEY RADIOLOGY ASSOCIATES
BOSTON MA
02241-0001
US

V. Phone/Fax

Practice location:
  • Phone: 617-243-6162
  • Fax: 617-243-5393
Mailing address:
  • Phone: 800-360-4391
  • Fax: 770-116-5702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN L MILLER
Title or Position: PRESIDENT
Credential: MD
Phone: 617-243-6600