=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790897114
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARLBOROUGH RADIOLOGY ASSOCIATES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 157 UNION ST
-----------------------------------------------------
City | MARLBOROUGH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01752-1228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-486-5495
-----------------------------------------------------
Fax | 508-229-1241
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 CAROL LN
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02420-4411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-486-5495
-----------------------------------------------------
Fax | 508-229-1241
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JONATHAN R. ARNOW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 508-486-5495
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------