Healthcare Provider Details

I. General information

NPI: 1457478000
Provider Name (Legal Business Name): INMED DIAGNOSTIC SERVICES OF MASSACHUSETTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 LONGWATER DR STE 105
NORWELL MA
02061-1639
US

IV. Provider business mailing address

2400 E COMMERCIAL BLVD SUITE 826
FT LAUDERDALE FL
33308-4054
US

V. Phone/Fax

Practice location:
  • Phone: 781-878-4004
  • Fax: 781-878-4075
Mailing address:
  • Phone: 954-510-3700
  • Fax: 954-510-2649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number232640
License Number StateMA

VIII. Authorized Official

Name: TONI COOPER
Title or Position: AM
Credential:
Phone: 754-206-6198