Healthcare Provider Details

I. General information

NPI: 1700859451
Provider Name (Legal Business Name): CONCORD IMAGING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 1/2 BEACON ST
CONCORD NH
03301-4447
US

IV. Provider business mailing address

2 1/2 BEACON ST
CONCORD NH
03301-4447
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-1521
  • Fax: 603-225-2510
Mailing address:
  • Phone: 603-228-1521
  • Fax: 603-225-2510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY J MCCORMACK
Title or Position: DIRECTOR
Credential: MD
Phone: 603-228-1521