Healthcare Provider Details

I. General information

NPI: 1598872350
Provider Name (Legal Business Name): ADI ADVANCED DIGITAL IMAGING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 STILES ROAD SUITE 206
SALEM NH
03079
US

IV. Provider business mailing address

PO BOX 1784
SALEM NH
03079
US

V. Phone/Fax

Practice location:
  • Phone: 603-893-1893
  • Fax: 603-893-2456
Mailing address:
  • Phone: 603-893-1893
  • Fax: 603-893-2456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MANUEL J SOUSA
Title or Position: OWNER
Credential: DDS
Phone: 603-893-1893