=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457300584
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UMASS MEMORIAL MRI - MARLBOROUGH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2006
-----------------------------------------------------
Last Update Date | 06/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 157 UNION ST
-----------------------------------------------------
City | MARLBOROUGH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01752-1228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-486-5674
-----------------------------------------------------
Fax | 508-486-5451
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 CONGRESS ST STE 204
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02169-0928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | KRISTEN DELMORE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 617-376-7400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1200X
-----------------------------------------------------
Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
-----------------------------------------------------
License Number | 4WMC
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------