Provider Demographics
NPI:1053621219
Name:BAILEY, BRIAN J (BS RT(R)(MR), RDMS)
Entity type:Individual
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First Name:BRIAN
Middle Name:J
Last Name:BAILEY
Suffix:
Gender:M
Credentials:BS RT(R)(MR), RDMS
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Mailing Address - Street 1:PO BOX 1819
Mailing Address - Street 2:LGH MEDICAL GROUP, INC.
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01853-1819
Mailing Address - Country:US
Mailing Address - Phone:978-937-6000
Mailing Address - Fax:
Practice Address - Street 1:295 VARNUM AVE
Practice Address - Street 2:LGH MEDICAL GROUP, INC ATTN: BUSINESS OFFICE
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2134
Practice Address - Country:US
Practice Address - Phone:978-937-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
272918OtherTHE AMERICAN REGISTRY OF RADIOLOGIC TECHNOLOGISTS
37312OtherARDMS