National Provider Identifier Database

PROVIDENCE DIAGNOSTIC IMAGING INC
Diagnostic Radiology

A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

Contact Information

PROVIDENCE DIAGNOSTIC IMAGING, INC.
271 CAREW ST
SPRINGFIELD, MA  01104-2377
Phone: 413-748-9200
Fax:
Website:
Specialty Taxonomy Code
* Diagnostic Radiology 2085R0202X
Body Imaging 2085B0100X
Diagnostic Ultrasound 2085U0001X
Neuroradiology 2085N0700X
Nuclear Radiology 2085N0904X
Vascular & Interventional Radiology 2085R0204X

* Indicates primary specialty

NPI Profile & details for PROVIDENCE DIAGNOSTIC IMAGING, INC.

NPI Number 1609978170
Legal business name
LBN		 PROVIDENCE DIAGNOSTIC IMAGING, INC.
Authorized official GREGORY BLACKMAN - (PRESIDENT)
Entity Organization
Organization subpart No
Enumeration date 09/03/2006
Last updated 07/01/2015 - About 11 years ago
Sole proprietor1 Not specified
Identifiers
  • CT Medicaid: 003126358
  • MA Medicaid: 9776559
  • Other: 774327 CONNECTICARE
  • Other: 1601748 EVERCARE
  • Other: CA7920 RAILROAD MEDICARE
  • Other: 102940700 US DEPARTMENT OF LABOR
  • MA Other: 783230 AETNA/US HEALTHCARE
  • MA Other: M16237 BLUE CROSS/BLUE SHIELD
  • MA Other: 000000025268 BMC HEALTHNET PLAN
  • MA Other: 98133101 NETWORK HEALTH
  • MA Other: 755228 TUFTS

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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