Healthcare Provider Details

I. General information

NPI: 1326091711
Provider Name (Legal Business Name): CRANSTON MRI PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1076 N MAIN ST
PROVIDENCE RI
02904-5760
US

IV. Provider business mailing address

400 W CUMMINGS PARK SUITE 6475
WOBURN MA
01801-6519
US

V. Phone/Fax

Practice location:
  • Phone: 401-421-5191
  • Fax: 401-421-1260
Mailing address:
  • Phone: 781-569-6541
  • Fax: 781-569-6557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberRAD1063
License Number StateRI

VIII. Authorized Official

Name: ROBERT A SANTAMARIA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 781-569-6541