Provider Demographics
NPI:1043298821
Name:NEWTON WELLESLEY RADIOLOGY ASSOC
Entity Type:Organization
Organization Name:NEWTON WELLESLEY RADIOLOGY ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-243-6600
Mailing Address - Street 1:PO BOX 417400
Mailing Address - Street 2:NEWTON WELLESLEY RADIOLOGY ASSOCIATES
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-0001
Mailing Address - Country:US
Mailing Address - Phone:800-360-4391
Mailing Address - Fax:770-116-5702
Practice Address - Street 1:2014 WASHINGTON ST
Practice Address - Street 2:NEWTON WELLESLEY RADIOLOGY ASSOCIATES
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1607
Practice Address - Country:US
Practice Address - Phone:617-243-6162
Practice Address - Fax:617-243-5393
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH HANELIN MD INC HAROLD SIMON MD INC & DAVID CARLSON MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-03
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9713115Medicaid
MAM12593Medicare PIN