1124458120 NPI number — LUNG SPECIALISTS OF MERRIMACK

Table of content: (NPI 1124458120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124458120 NPI number — LUNG SPECIALISTS OF MERRIMACK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUNG SPECIALISTS OF MERRIMACK
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LUNG SPECIALISTS OF THE MERRIMACK VALLEY, P.C.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124458120
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275 VARNUM AVE
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
LOWELL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01854-2141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-934-9220
Provider Business Mailing Address Fax Number:
978-453-7771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
275 VARNUM AVE
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
LOWELL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01854-2141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-934-9220
Provider Business Practice Location Address Fax Number:
978-453-7771
Provider Enumeration Date:
11/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LIN
Authorized Official First Name:
DENIS
Authorized Official Middle Name:
Y
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
978-934-9220

Provider Taxonomy Codes

  • Taxonomy code: 207RS0012X , with the licence number:  71291 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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