Healthcare Provider Details

I. General information

NPI: 1831161470
Provider Name (Legal Business Name): BRISTOL IMAGING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 HEMPHILL RD BRISTOL IMAGING PC
BRISTOL NH
03222-0513
US

IV. Provider business mailing address

PO BOX 513 225 HEMPHILL ROAD
BRISTOL NH
03222-0513
US

V. Phone/Fax

Practice location:
  • Phone: 603-744-2753
  • Fax: 603-744-2980
Mailing address:
  • Phone: 603-744-2753
  • Fax: 603-744-2980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number150377
License Number StateMA

VIII. Authorized Official

Name: DR. CARL WARNER CARLSON
Title or Position: CEO
Credential: MD
Phone: 603-744-2753