Provider Demographics
NPI:1194249490
Name:SHIELDS RADIOLOGY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:SHIELDS RADIOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:SWERIDUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-258-4674
Mailing Address - Street 1:55 CHRISTY DR
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1813
Mailing Address - Country:US
Mailing Address - Phone:508-897-1501
Mailing Address - Fax:508-897-1599
Practice Address - Street 1:265 WESTGATE DR STE 2
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1817
Practice Address - Country:US
Practice Address - Phone:800-258-4574
Practice Address - Fax:800-253-7569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic RadiologyGroup - Single Specialty