MEDICARE: AURORA BREAST MRI OF CENTRAL MASSACHUSETTS, 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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number	:	1437247244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AURORA BREAST MRI OF CENTRAL MASSACHUSETTS, LLC

Provider Business Mailing Address
First Line	:	39 HIGH ST
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-2637
Country	:	US
Telephone Number	:	978-975-7530
Fax Number	:

Provider Business Practice Location Address
First Line	:	67 BELMONT ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01605-2657
Country	:	US
Telephone Number	:	508-459-7480
Fax Number	:

Authorized Official
Title or Position	:	CLINIC ADMINISTRATOR
Name	:	SHARON FANDEL
Credential	:
Telephone Number	:	978-975-7530

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	01/19/2012

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