Provider Demographics
NPI:1487690335
Name:IMAGING CONSULTANTS INC
Entity type:Organization
Organization Name:IMAGING CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-552-2600
Mailing Address - Street 1:100 BAYVIEW CIR STE 400
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2984
Mailing Address - Country:US
Mailing Address - Phone:949-242-5384
Mailing Address - Fax:
Practice Address - Street 1:761 WORCESTER RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-5224
Practice Address - Country:US
Practice Address - Phone:866-245-5995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2010-08-17
Deactivation Date:2006-06-22
Deactivation Code:
Reactivation Date:2007-11-26
Provider Licenses
StateLicense IDTaxonomies
MA440327261QR0200X
261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA036769OtherBCBS
MA785146OtherCONNECTICARE
MA0008850OtherNEIGHBORHOOD HEALTH PLAN
MA36984OtherFALLON
MA0421008OtherCIGNA / HEALTHSOURCE
MA1529871Medicaid
MAP00021368OtherRAILROAD MEDICARE
MA346646400OtherU.S. DEPT OF LABOR OWCP
MA626264OtherHARVARD PILGRIM HLTH CARE
MA713587OtherTUFTS/ SECURE HORIZONS
MA81020OtherAETNA
MA81020OtherAETNA