Provider Demographics
NPI:1942609359
Name:CAREWELL RADIOLOGY GROUP
Entity Type:Organization
Organization Name:CAREWELL RADIOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-302-4194
Mailing Address - Street 1:2 ADAMS PL
Mailing Address - Street 2:SUITE 305
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7456
Mailing Address - Country:US
Mailing Address - Phone:617-302-4194
Mailing Address - Fax:
Practice Address - Street 1:2 ADAMS PL
Practice Address - Street 2:SUITE 305
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7456
Practice Address - Country:US
Practice Address - Phone:617-302-4194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10942261QR0200X
MA11061261QR0200X
MA11175261QR0200X
MA11083261QR0200X
MA11055261QR0200X
MA11109261QR0200X
MA11064261QR0200X
MA11051261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology