MEDICARE: NEW ENGLAND RADIOLOGICAL CONSORTIUM, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1174414882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW ENGLAND RADIOLOGICAL CONSORTIUM, LLC

Provider Business Mailing Address
First Line	:	998 OCEAN BLVD
Second Line	:
City	:	HAMPTON
State	:	NH
Zip	:	03842-1429
Country	:	US
Telephone Number	:	833-821-3774
Fax Number	:

Provider Business Practice Location Address
First Line	:	998 OCEAN BLVD
Second Line	:
City	:	HAMPTON
State	:	NH
Zip	:	03842-1429
Country	:	US
Telephone Number	:	757-672-0297
Fax Number	:

Authorized Official
Title or Position	:	OWNER, AUTHORIZED OFFICIAL
Name	:	MATTHEW DOUGLAS MOORE SR.
Credential	:	MD
Telephone Number	:	833-821-3774

Provider Enumeration Date	:	07/11/2025
Last Update Date	:	04/16/2026

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