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General NPI Number Information
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NPI Number | 1407833908
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Entity Type | Organization
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Legal Business Name | NORWICH DIAGNOSTIC IMAGING ASSOCIATES P.C
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 02/14/2018
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Provider Practice Location Address
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Address Line | 326 WASHINGTON ST
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City | NORWICH
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State | CT
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Zip | 06360-2740
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Country | US
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Telephone | 860-889-8331
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9132
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City | BROOKLINE
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State | MA
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Zip | 02446-9132
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Country | US
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Telephone | 800-927-0002
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PHILLIP KOHANSKI
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Credential | MD
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Telephone | 800-927-0002
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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 | CT
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