Basic Information
| Provider Information | |||||||||
| NPI: | 1053621219 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | BS RT(R)(MR), RDMS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1819 | ||||||||
| Address2: | LGH MEDICAL GROUP, INC. | ||||||||
| City: | LOWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018531819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789376000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 295 VARNUM AVE | ||||||||
| Address2: | LGH MEDICAL GROUP, INC ATTN: BUSINESS OFFICE | ||||||||
| City: | LOWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018542134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789376000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2010 | ||||||||
| LastUpdateDate: | 10/20/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247100000X | N | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | 2471S1302X | Y | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Sonography | 2471V0105X | N | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Vascular Sonography |
ID Information
| ID | Type | State | Issuer | Description | 272918 | 01 | THE AMERICAN REGISTRY OF RADIOLOGIC TECHNOLOGISTS | OTHER | 37312 | 01 | ARDMS | OTHER |