Healthcare Provider Details

I. General information

NPI: 1538220694
Provider Name (Legal Business Name): COVENTRY IMAGING ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 SANDY BOTTOM ROAD
COVENTRY RI
02816
US

IV. Provider business mailing address

1725 MENDON ROAD SUITE 207
CUMBERLAND RI
02864
US

V. Phone/Fax

Practice location:
  • Phone: 401-822-8700
  • Fax:
Mailing address:
  • Phone: 401-334-2423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES ROSENTHAL
Title or Position: PRESIDENT
Credential: MD
Phone: 401-822-8700