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General NPI Number Information
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NPI Number | 1467625244
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE RADIOLOGY, PLLC
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Dates
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Enumeration Date | 04/11/2008
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Last Update Date | 04/11/2008
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Provider Practice Location Address
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Address Line | 600 SAINT JOHNSBURY RD
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City | LITTLETON
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State | NH
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Zip | 03561-3442
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Country | US
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Telephone | 603-444-9577
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Fax |
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Provider Business Mailing Address
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Address Line | 1 HARDY HILL RD
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City | LEBANON
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State | NH
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Zip | 03766-2012
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Country | US
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Telephone | 603-252-7447
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Fax | 603-658-0484
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Authorized Official
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Title or Position | MANAGER
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Name | DR. LESLY BEODIN
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Credential | M.D.
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Telephone | 603-252-7447
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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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