Provider Demographics
NPI:1790758449
Name:X-RAY PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:X-RAY PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCORMACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-228-1521
Mailing Address - Street 1:2 1/2 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4447
Mailing Address - Country:US
Mailing Address - Phone:603-228-1521
Mailing Address - Fax:603-225-2510
Practice Address - Street 1:2 1/2 BEACON ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4447
Practice Address - Country:US
Practice Address - Phone:603-228-1521
Practice Address - Fax:603-225-2510
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:X-RAY PROFESSIONAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-10
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHXRAY300249OtherANTHEM BCBS OF NH
NH99000249Medicaid
NHCB4403OtherRAILROAD MEDICARE
NHNH0249Medicare PIN