MEDICARE: AROOSTOOK DIAGNOSTIC IMAGING

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	261QR0200X	Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A0900	OTHER	ME	BC/BS

General Provider Information

NPI Number	:	1689670705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AROOSTOOK DIAGNOSTIC IMAGING

Provider Business Mailing Address
First Line	:	PO BOX 1849
Second Line	:
City	:	LEWISTON
State	:	ME
Zip	:	04241-1849
Country	:	US
Telephone Number	:	207-784-2554
Fax Number	:	207-783-4079

Provider Business Practice Location Address
First Line	:	20 HARTFORD ST
Second Line	:
City	:	HOULTON
State	:	ME
Zip	:	04730-1891
Country	:	US
Telephone Number	:	207-532-9471
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PETER J MASCETTA
Credential	:	D.O.
Telephone Number	:	207-532-9471

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	08/22/2020

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