Healthcare Provider Details

I. General information

NPI: 1053353599
Provider Name (Legal Business Name): NORTH SHORE MAGNETIC IMAGING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 PROSPECT ST
PEABODY MA
01960-1605
US

IV. Provider business mailing address

68 PROSPECT ST
PEABODY MA
01960-1605
US

V. Phone/Fax

Practice location:
  • Phone: 978-532-8960
  • Fax: 978-532-0633
Mailing address:
  • Phone: 978-532-8960
  • Fax: 978-532-0633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number4385
License Number StateMA

VIII. Authorized Official

Name: MS. ELEANOR NONE RICHARDSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 978-573-3116