=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891021085
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BREAST IMAGING PHYSICIANS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2009
-----------------------------------------------------
Last Update Date | 10/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 165 WORCESTER ST
-----------------------------------------------------
City | WELLESLEY HILLS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02481-3615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-927-0002
-----------------------------------------------------
Fax | 603-893-8886
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9135
-----------------------------------------------------
City | BROOKLINE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02446-9135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-890-4404
-----------------------------------------------------
Fax | 603-893-8886
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ELSIE LEVIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 800-927-0002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------