Basic Information
| Provider Information | |||||||||
| NPI: | 1144455791 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHELMSFORD MRI, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5775 WAYZATA BLVD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | ST LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554161222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525256338 | ||||||||
| FaxNumber: | 9525136880 | ||||||||
| Practice Location | |||||||||
| Address1: | 187 BILLERICA RD | ||||||||
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| City: | CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018243616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782501866 | ||||||||
| FaxNumber: | 9782569536 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2009 | ||||||||
| LastUpdateDate: | 04/16/2020 | ||||||||
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| AuthorizedOfficialLastName: | BLOOM | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6172360220 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 04/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.