Healthcare Provider Details

I. General information

NPI: 1477358372
Provider Name (Legal Business Name): NEW ENGLAND MOLECULAR IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 DURHAM RD
DOVER NH
03820-4380
US

IV. Provider business mailing address

PO BOX 735651
DALLAS TX
75373-5651
US

V. Phone/Fax

Practice location:
  • Phone: 603-537-1363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GREG GAMBILL
Title or Position: VP AND ASSOCIATE GENERAL COUNSEL
Credential:
Phone: 303-414-2037