Provider Demographics
NPI:1790897114
Name:MARLBOROUGH RADIOLOGY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:MARLBOROUGH RADIOLOGY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ARNOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-486-5495
Mailing Address - Street 1:4 CAROL LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4411
Mailing Address - Country:US
Mailing Address - Phone:508-486-5495
Mailing Address - Fax:508-229-1241
Practice Address - Street 1:157 UNION ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-1228
Practice Address - Country:US
Practice Address - Phone:508-486-5495
Practice Address - Fax:508-229-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9713824Medicaid
MA9713824Medicaid