Provider Demographics
NPI:1063542348
Name:NORWICH RADIOLOGY GROUP, P.C.
Entity type:Organization
Organization Name:NORWICH RADIOLOGY GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:I
Authorized Official - Last Name:DALAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-928-1166
Mailing Address - Street 1:39 KENNEDY DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1939
Mailing Address - Country:US
Mailing Address - Phone:860-928-1166
Mailing Address - Fax:860-928-1162
Practice Address - Street 1:39 KENNEDY DR
Practice Address - Street 2:SUITE D
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1939
Practice Address - Country:US
Practice Address - Phone:860-928-1166
Practice Address - Fax:860-928-1162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00136Medicare ID - Type Unspecified