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General NPI Number Information
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NPI Number | 1700882891
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Entity Type | Organization
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Legal Business Name | BELFAST BAY RADIOLOGY
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Dates
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Enumeration Date | 06/23/2005
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 118 NORTHPORT AVE
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City | BELFAST
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State | ME
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Zip | 04915-6009
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Country | US
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Telephone | 207-338-2500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 986520 DEPARTMENT 120
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City | BOSTON
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State | MA
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Zip | 02298-6520
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Country | US
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Telephone | 207-784-2554
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Fax | 207-777-1439
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Authorized Official
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Title or Position | PRESIDENT
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Name | GREGORY GROTZ
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Credential | MD
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Telephone | 207-338-2500
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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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