Provider Demographics
NPI:1023063054
Name:SHARED DIAGNOSTIC SERVICES, INC
Entity type:Organization
Organization Name:SHARED DIAGNOSTIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:ARDMS
Authorized Official - Phone:781-340-2494
Mailing Address - Street 1:143 FEDERAL ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02188-2812
Mailing Address - Country:US
Mailing Address - Phone:781-340-2494
Mailing Address - Fax:781-340-2499
Practice Address - Street 1:799 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1048
Practice Address - Country:US
Practice Address - Phone:617-868-9191
Practice Address - Fax:617-868-1490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty