Provider Demographics
NPI:1851348106
Name:CARITAS CHRISTI DIAGNOSTIC SUPPORT SERVICES
Entity Type:Organization
Organization Name:CARITAS CHRISTI DIAGNOSTIC SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-789-2500
Mailing Address - Street 1:736 CAMBRIDGE STREET
Mailing Address - Street 2:C/O CARITAS ST. ELIZABETH'S MEDICAL CENTER
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2907
Mailing Address - Country:US
Mailing Address - Phone:617-562-5491
Mailing Address - Fax:617-562-5481
Practice Address - Street 1:736 CAMBRIDGE STREET
Practice Address - Street 2:C/O CARITAS ST. ELIZABETH'S MEDICAL CENTER
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-562-5491
Practice Address - Fax:617-562-5481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471V0106XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular-Interventional TechnologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1532189Medicaid
MA1532189Medicaid