Provider Demographics
NPI:1316729791
Name:COMMONWEALTH MOBILE MEDICAL IMAGING
Entity type:Organization
Organization Name:COMMONWEALTH MOBILE MEDICAL IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER (MANAGER)
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEZZA
Authorized Official - Suffix:
Authorized Official - Credentials:RT(R) VI
Authorized Official - Phone:781-956-9698
Mailing Address - Street 1:770 WASHINGTON ST STE C
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-2169
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:770 WASHINGTON ST STE C
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-2169
Practice Address - Country:US
Practice Address - Phone:781-956-9698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-19
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile