Provider Demographics
NPI:1316059082
Name:HALLMARK IMAGING ASSOCIATES, PC
Entity type:Organization
Organization Name:HALLMARK IMAGING ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:HENRIKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-710-2675
Mailing Address - Street 1:85 FERDINAND ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-1154
Mailing Address - Country:US
Mailing Address - Phone:781-710-2675
Mailing Address - Fax:781-979-3994
Practice Address - Street 1:585 LEBANON ST
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3225
Practice Address - Country:US
Practice Address - Phone:781-979-3120
Practice Address - Fax:781-979-3994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9787399Medicaid
MA9787399Medicaid