Provider Demographics
NPI:1447332762
Name:GREYLOCK RADIOLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:GREYLOCK RADIOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-664-5279
Mailing Address - Street 1:291 MOODY ST
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-1246
Mailing Address - Country:US
Mailing Address - Phone:800-688-6663
Mailing Address - Fax:413-589-7554
Practice Address - Street 1:71 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-2504
Practice Address - Country:US
Practice Address - Phone:413-664-5279
Practice Address - Fax:413-589-7554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9724818Medicaid
102211300OtherUS DEPT OF LABOR
VT1000545Medicaid
MA110068739/AMedicaid
MAM13630OtherBC/BS
NY00743691Medicaid
MAM13630OtherBC/BS