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General NPI Number Information
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NPI Number | 1245440726
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Entity Type | Organization
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Legal Business Name | MMDS OF BOSTON LLC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 05/09/2014
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Provider Practice Location Address
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Address Line | 48 SILVER LAKE AVE.
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City | NEWTON
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State | MA
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Zip | 02458-1111
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Country | US
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Telephone | 617-244-9729
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Fax |
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Provider Business Mailing Address
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Address Line | 48 SILVER LAKE AVE.
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City | NEWTON
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State | MA
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Zip | 02458-1111
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Country | US
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Telephone | 617-244-9729
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, CEO
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Name | MR. RICHARD SCOTT GRINLEY
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Credential | M.ED.
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Telephone | 617-244-9729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471C3402X
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Taxonomy Name | Radiography Radiologic Technologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number |
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License Number State |
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