NPIMap

Organization Active NPI

Madison Radiology PC

Doing business as Old Lyme Radiology

  • Mammography Clinic/Center
  • Madison, CT
National Provider Identifier
1457382855
Registry record updated Jul 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mammography Clinic/CenterTaxonomy code 261QR0206X
License
02643 Issued in CT
Legal business name
MADISON RADIOLOGY PC
Doing business as
Old Lyme Radiology
Practice address
2 Samson Rock Dr
Madison, CT 06443-9998
Phone
(203) 245-7351
Fax
(203) 245-8838
NPI assigned
Jul 5, 2006
Last updated
Jul 18, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
MADISON RADIOLOGY, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 18, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Mary Walby
Title
Office Manager
Phone
(203) 245-7351

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mammography Clinic/Center 261QR0206X 02643 CT Primary

Addresses

Primary practice location

2 Samson Rock Dr
Madison, CT 06443-9998

Mailing address

2 Samson Rock Dr
Madison, CT 06443-9998
Phone (203) 245-7351

Other names 1

  • Old Lyme Radiology Doing business as

National Provider Directory

National Provider Directory
Part of
Madison Radiology PC

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216339200000",
    "number": "1457382855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 SAMSON ROCK DR",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064439998",
            "telephone_number": "203-245-7351",
            "fax_number": "203-245-8838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 SAMSON ROCK DR",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064439998",
            "telephone_number": "203-245-7351",
            "fax_number": "203-245-8838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON RADIOLOGY PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MADISON RADIOLOGY, PC",
        "enumeration_date": "2006-07-05",
        "last_updated": "2008-07-18",
        "status": "A",
        "authorized_official_last_name": "WALBY",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "203-245-7351",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": "CT",
            "license": "02643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Old Lyme Radiology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.