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General NPI Number Information
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NPI Number | 1861660201
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Entity Type | Individual
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Provider Name | JILLIAN S IMAGIRE M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/20/2008
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Last Update Date | 02/20/2008
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Provider Practice Location Address
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Address Line | CONCERT PHARMACEUTICALS 99 HAYDEN AVE, SUITE 100
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City | LEXINGTON
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State | MA
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Zip | 02421
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Country | US
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Telephone | 781-860-0045
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Fax |
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Provider Business Mailing Address
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Address Line | 3 BURNHAM RD
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City | LEXINGTON
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State | MA
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Zip | 02420-1905
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Country | US
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Telephone | 781-860-0045
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 152299
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License Number State | MA
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