Healthcare Provider Details

I. General information

NPI: 1962443861
Provider Name (Legal Business Name): ADVANCED DIAGNOSTIC IMAGING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 ALUMNI DRIVE
EXETER NH
03833-2128
US

IV. Provider business mailing address

PO BOX 986520 DEPARTMENT 100
BOSTON MA
02298-6520
US

V. Phone/Fax

Practice location:
  • Phone: 603-580-6608
  • Fax: 603-580-6707
Mailing address:
  • Phone: 207-784-2554
  • Fax: 207-777-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL MURPHY
Title or Position: PRESIDENT
Credential: MD
Phone: 603-778-7311