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General NPI Number Information
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NPI Number | 1952400152
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Entity Type | Organization
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Legal Business Name | JOHN FITCH RADIOLOGY
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1480 JOHN FITCH HIGHWAY 1480 JOHN FITCH HIGHWAY
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City | FITCHBURG
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State | MA
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Zip | 01420
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Country | US
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Telephone | 978-342-6990
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Fax | 978-345-6932
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Provider Business Mailing Address
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Address Line | 1480 JOHN FITCH HIGHWAY 1480 JOHN FITCH HIGHWAY
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City | FITCHBURG
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State | MA
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Zip | 01420
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Country | US
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Telephone | 978-342-6990
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Fax | 978-345-6932
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Authorized Official
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Title or Position | ORTHOPAEDIC SURGEON
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Name | STEVEN A MANALAN
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Credential | MD
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Telephone | 978-345-0343
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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 | 4504
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License Number State | MA
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