Healthcare Provider Details

I. General information

NPI: 1407898760
Provider Name (Legal Business Name): NORTH SHORE PET IMAGING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
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: 978-532-9163
Mailing address:
  • Phone: 978-532-8960
  • Fax: 978-532-9163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number4C5F
License Number StateMA

VIII. Authorized Official

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