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General NPI Number Information
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NPI Number | 1598741324
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Entity Type | Organization
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Legal Business Name | MONTVALE IMAGING PHYSICIANS PC
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 48 MONTVALE AVE
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City | STONEHAM
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State | MA
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Zip | 02180-2425
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Country | US
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Telephone | 781-279-2213
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9137
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City | BROOKLINE
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State | MA
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Zip | 02446-9137
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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 | MD
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Name | GERARD O'REILLY
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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 | MA
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