Provider Demographics
NPI:1821615196
Name:DIAGNOSTIC IMAGING OF MILFORD, PC
Entity Type:Organization
Organization Name:DIAGNOSTIC IMAGING OF MILFORD, PC
Other - Org Name:MILFORD VASCULAR INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-878-2341
Mailing Address - Street 1:PO BOX 329
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-0329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 COMMERCE PARK
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3511
Practice Address - Country:US
Practice Address - Phone:203-882-8346
Practice Address - Fax:203-882-0384
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIAGNOSTIC IMAGING OF MILFORD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-02
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT7823760001OtherNSC MEDICARE