Basic Information
| Provider Information | |||||||||
| NPI: | 1194761692 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHAMPTON RADIOLOGIC ASSOCIATES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 291 MOODY ST | ||||||||
| Address2: | |||||||||
| City: | LUDLOW | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010561246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006886666 | ||||||||
| FaxNumber: | 4135897554 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 LOCUST ST | ||||||||
| Address2: | |||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010602052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135822101 | ||||||||
| FaxNumber: | 4135822949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 07/15/2020 | ||||||||
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| AuthorizedOfficialLastName: | POLINO | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4136958367 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 701726 | 01 | MA | TUFTS | OTHER | 9721185 | 05 | MA | MEDICAID | 0012697 | 01 | MA | AETNA | OTHER | 0008277 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | 1006064 | 01 | VT | MEDICAID | OTHER | 686823 | 01 | MA | CONNECTICARE | OTHER | 101822800 | 01 | MA | US DEPT. OF LABOR | OTHER | CM0600 | 01 | MA | RAILRAOD MEDICARE | OTHER |