Provider Demographics
NPI:1356340871
Name:DIAGNOSTIC ULTRASOUND ASSOCIATES, PC
Entity type:Organization
Organization Name:DIAGNOSTIC ULTRASOUND ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERYL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BENACERRAF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-739-0245
Mailing Address - Street 1:1 BROOKLINE PL
Mailing Address - Street 2:SUITE 506
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7224
Mailing Address - Country:US
Mailing Address - Phone:617-739-0245
Mailing Address - Fax:617-738-6703
Practice Address - Street 1:1 BROOKLINE PL
Practice Address - Street 2:SUITE 506
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7224
Practice Address - Country:US
Practice Address - Phone:617-739-0245
Practice Address - Fax:617-738-6703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9764992Medicaid
MA9764992Medicaid