Provider Demographics
NPI:1730559444
Name:SOUTHERN NEW ENGLAND RADIOLOGY INC
Entity type:Organization
Organization Name:SOUTHERN NEW ENGLAND RADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-973-7581
Mailing Address - Street 1:1342 BELMONT ST STE 205
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4438
Mailing Address - Country:US
Mailing Address - Phone:508-973-7581
Mailing Address - Fax:508-961-5341
Practice Address - Street 1:363 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3703
Practice Address - Country:US
Practice Address - Phone:508-973-7581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty