Healthcare Provider Details

I. General information

NPI: 1154875557
Provider Name (Legal Business Name): NORTH SHORE RADIOLOGICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 08/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 HIGHLAND AVE
WINCHESTER MA
01890-1446
US

IV. Provider business mailing address

PO BOX 6750
PORTSMOUTH NH
03802-6750
US

V. Phone/Fax

Practice location:
  • Phone: 781-756-2342
  • Fax:
Mailing address:
  • Phone: 800-208-7069
  • Fax: 610-956-0009

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: DR. JOHN DUBROW
Title or Position: PRESIDENT
Credential: MD
Phone: 603-943-5580