Healthcare Provider Details

I. General information

NPI: 1932153863
Provider Name (Legal Business Name): MAGNETIC RESONANCE IMAGING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 STATE ST
BANGOR ME
04401-6616
US

IV. Provider business mailing address

PO BOX 1188
BANGOR ME
04402-1188
US

V. Phone/Fax

Practice location:
  • Phone: 207-945-4680
  • Fax: 207-945-4689
Mailing address:
  • Phone: 207-945-4680
  • Fax: 207-945-4689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: EDWARD NICHOLAS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 207-945-4680