Provider Demographics
NPI:1295106136
Name:MMDS OF BOSTON
Entity type:Organization
Organization Name:MMDS OF BOSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GRINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:617-244-9729
Mailing Address - Street 1:48 SILVER LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1111
Mailing Address - Country:US
Mailing Address - Phone:617-244-9729
Mailing Address - Fax:617-244-9730
Practice Address - Street 1:95 EDDY RD
Practice Address - Street 2:SUITE 611
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3266
Practice Address - Country:US
Practice Address - Phone:617-244-9729
Practice Address - Fax:617-244-9730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1943M335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier