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General NPI Number Information
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NPI Number | 1255739454
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Entity Type | Organization
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Legal Business Name | DDM RADIOLOGY PC
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Dates
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Enumeration Date | 12/21/2014
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Last Update Date | 12/21/2014
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Provider Practice Location Address
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Address Line | 18 HOLMES RD
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City | LEXINGTON
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State | MA
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Zip | 02420-1917
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Country | US
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Telephone | 781-258-0197
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Fax | 781-862-5946
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Provider Business Mailing Address
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Address Line | 18 HOLMES RD
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City | LEXINGTON
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State | MA
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Zip | 02420-1917
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Country | US
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Telephone | 781-258-0197
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Fax | 781-862-5946
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SANFORD SMOOT
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Credential | MD
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Telephone | 781-258-0197
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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 | 51966
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License Number State | MA
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