Provider Demographics
NPI:1386832723
Name:WEYMOUTH MRI PC
Entity Type:Organization
Organization Name:WEYMOUTH MRI PC
Other - Org Name:SEACOAST ADVANCED DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:ESQUIRE
Authorized Official - Phone:781-331-9880
Mailing Address - Street 1:3 CEDARHILL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-1905
Mailing Address - Country:US
Mailing Address - Phone:508-888-2270
Mailing Address - Fax:508-888-2544
Practice Address - Street 1:3 CEDARHILL PARK DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2226
Practice Address - Country:US
Practice Address - Phone:508-888-2270
Practice Address - Fax:508-888-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1530160Medicaid