Healthcare Provider Details

I. General information

NPI: 1932163151
Provider Name (Legal Business Name): INMED DIAGNOSTIC SERVICES OF MASSACHUSETTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 WOODLAND RD SUITE 217
STONEHAM MA
02180-1702
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 781-662-4300
  • Fax: 781-662-4980
Mailing address:
  • Phone: 954-510-3700
  • Fax: 954-510-2649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH LONGTON
Title or Position: COO
Credential:
Phone: 954-510-3704