Healthcare Provider Details

I. General information

NPI: 1487899035
Provider Name (Legal Business Name): SALEM RADIOLOGY LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 STILES RD STE 102
SALEM NH
03079-2859
US

IV. Provider business mailing address

23 STILES RD STE 102
SALEM NH
03079-2859
US

V. Phone/Fax

Practice location:
  • Phone: 603-893-4352
  • Fax: 603-894-4522
Mailing address:
  • Phone: 603-893-4352
  • Fax: 603-894-4522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT HANNON
Title or Position: SENIOR PARTNER
Credential: MD
Phone: 603-893-4352