Provider Demographics
NPI:1831161470
Name:BRISTOL IMAGING PC
Entity type:Organization
Organization Name:BRISTOL IMAGING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:WARNER
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-744-2753
Mailing Address - Street 1:PO BOX 513
Mailing Address - Street 2:225 HEMPHILL ROAD
Mailing Address - City:BRISTOL
Mailing Address - State:NH
Mailing Address - Zip Code:03222-0513
Mailing Address - Country:US
Mailing Address - Phone:603-744-2753
Mailing Address - Fax:603-744-2980
Practice Address - Street 1:225 HEMPHILL RD BRISTOL IMAGING PC
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:NH
Practice Address - Zip Code:03222-0513
Practice Address - Country:US
Practice Address - Phone:603-744-2753
Practice Address - Fax:603-744-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1503772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty