NPIMap

Organization Active NPI

Pentucket Medical Radiology

  • Radiology Clinic/Center
  • Haverhill, MA
National Provider Identifier
1790957470
Registry record updated May 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
License
09570 Issued in MA
Legal business name
PENTUCKET MEDICAL RADIOLOGY
Practice address
1 Parkway
Haverhill, MA 01830-6278
Phone
(978) 521-3260
Fax
(978) 469-5378
NPI assigned
Apr 2, 2008
Organization subpart
Yes
Parent organization
PENTUCKET MEDICAL ASSOCIATES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 16, 2011

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

Authorized official

Name
Dr. Thomas L. Fazio, MD
Title
President
Phone
(978) 521-3200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X 09570 MA Primary

Addresses

Primary practice location

1 Parkway
Haverhill, MA 01830-6278

Mailing address

1 Parkway
Haverhill, MA 01830-6278
Phone (978) 521-3260

Other identifiers 1

IdentifierTypeStateIssuer
0039516OtherMANEIGHBORHOOD HEALTH PLAN

National Provider Directory

National Provider Directory
Part of
Pentucket Medical Associates LLC

NPI Registry JSON

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

{
    "created_epoch": "1207094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305504000000",
    "number": "1790957470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PARKWAY",
            "city": "HAVERHILL",
            "state": "MA",
            "postal_code": "018306278",
            "telephone_number": "978-521-3260",
            "fax_number": "978-469-5378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PARKWAY",
            "city": "HAVERHILL",
            "state": "MA",
            "postal_code": "018306278",
            "telephone_number": "978-521-3260",
            "fax_number": "978-469-5378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENTUCKET MEDICAL RADIOLOGY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PENTUCKET MEDICAL ASSOCIATES, LLC",
        "enumeration_date": "2008-04-02",
        "last_updated": "2011-05-16",
        "status": "A",
        "authorized_official_last_name": "FAZIO",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "978-521-3200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "MA",
            "license": "09570",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIGHBORHOOD HEALTH PLAN",
            "identifier": "0039516",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Haverhill, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2011; 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.