Provider Demographics
NPI:1720030729
Name:FOREST PARK MRI ASSOCIATES, PC
Entity Type:Organization
Organization Name:FOREST PARK MRI ASSOCIATES, PC
Other - Org Name:THE MRI CENTER OF WOBURN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANTAMARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-569-6541
Mailing Address - Street 1:800 W CUMMINGS PARK
Mailing Address - Street 2:SUITE 1350
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6372
Mailing Address - Country:US
Mailing Address - Phone:781-569-6541
Mailing Address - Fax:781-569-6557
Practice Address - Street 1:800 W CUMMINGS PARK
Practice Address - Street 2:SUITE 1150
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6372
Practice Address - Country:US
Practice Address - Phone:781-932-8650
Practice Address - Fax:781-932-8619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110029170AMedicaid
MA0004301OtherMEDICARE IDTF PTAN