Provider Demographics
NPI:1609064997
Name:WEYMOUTH MRI LLC
Entity Type:Organization
Organization Name:WEYMOUTH MRI LLC
Other - Org Name:
Other - Org Type:
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 1:420 LIBBEY INDUSTRIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-3134
Mailing Address - Country:US
Mailing Address - Phone:781-331-9880
Mailing Address - Fax:781-974-1298
Practice Address - Street 1:420 LIBBEY INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3134
Practice Address - Country:US
Practice Address - Phone:781-331-9880
Practice Address - Fax:781-974-1298
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 Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1541251Medicaid