Basic Information
| Provider Information | |||||||||
| NPI: | 1437270055 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOLYOKE RADIOLOGISTS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 291 MOODY ST | ||||||||
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| City: | LUDLOW | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010561246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135890195 | ||||||||
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| Practice Location | |||||||||
| Address1: | 575 BEECH ST | ||||||||
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| City: | HOLYOKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010402223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135342523 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MALI | ||||||||
| AuthorizedOfficialFirstName: | MRINAL | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 4135890195 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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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 | 9711368 | 05 | MA | MEDICAID |