Provider Demographics
NPI:1396055356
Name:NORTH BRIDGE IMAGING GROUP, LLC
Entity type:Organization
Organization Name:NORTH BRIDGE IMAGING GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:I
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-287-3794
Mailing Address - Street 1:15 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-2928
Mailing Address - Country:US
Mailing Address - Phone:508-946-6898
Mailing Address - Fax:508-946-1494
Practice Address - Street 1:22 MILL ST
Practice Address - Street 2:SUITE 304
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4784
Practice Address - Country:US
Practice Address - Phone:508-946-6898
Practice Address - Fax:508-946-1494
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH BRIDGE IMAGING GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-08
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21200Medicare PIN