Provider Demographics
NPI:1760498034
Name:CARITAS MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:CARITAS MEDICAL GROUP INC.
Other - Org Name:CARITAS RADIOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIR, DEPT OF RADIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIRARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-789-2740
Mailing Address - Street 1:736 CAMBRIDGE ST
Mailing Address - Street 2:CMP 4
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2907
Mailing Address - Country:US
Mailing Address - Phone:617-789-2740
Mailing Address - Fax:617-779-6343
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:CMP 4
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-789-2740
Practice Address - Fax:617-779-6343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9781374Medicaid
MA9781374Medicaid