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General NPI Number Information
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NPI Number | 1043364920
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Entity Type | Organization
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Legal Business Name | COOLIDGE CORNER IMAGING, LLC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 12/07/2010
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Provider Practice Location Address
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Address Line | 356 HARVARD ST
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City | BROOKLINE
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State | MA
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Zip | 02446-2905
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Country | US
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Telephone | 617-383-6585
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Fax | 617-383-6592
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Provider Business Mailing Address
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Address Line | PO BOX 381289 31 SMITH PLACE
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City | CAMBRIDGE
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State | MA
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Zip | 02238-1289
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Country | US
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Telephone | 617-661-1949
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Fax | 617-661-1943
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JEAN PIERCE
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Credential |
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Telephone | 617-661-1949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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