Basic Information
| Provider Information | |||||||||
| NPI: | 1114398609 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FESTOG | ||||||||
| FirstName: | CHRISTINA | ||||||||
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| Credential: | RDMS, RVT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13 KELSEY RD | ||||||||
| Address2: | |||||||||
| City: | NATICK | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017603329 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 41 MALL RD | ||||||||
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| City: | BURLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018050001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817445100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2015 | ||||||||
| LastUpdateDate: | 10/09/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2471S1302X | Y | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Sonography | 2471V0105X | N | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Vascular Sonography |
No ID Information.