| Organization Name: | JEFFERSON RADIOLOGY, PC |
| NPI Number: | 1285685867 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT O'DONNELL (DIRECTOR, REVENUE SERVICES) |
| Mailing Address: | 1260 Silas Deane Hwy Suite 104 Wethersfield |
| State: | CT US |
| Postal Code: | 061094362 |
| Phone Number: | 8605637844 |
| Fax Number: | 8605637871 |
| NPI Enumeration Date: | 05/16/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085R0202X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Diagnostic Radiology |
| Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |