1578707162 NPI number — NORTHEAST MEDICAL GROUP, INC.

Table of content: (NPI 1578707162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578707162 NPI number — NORTHEAST MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST MEDICAL GROUP, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1578707162
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275 VARNUM AVENUE
Provider Second Line Business Mailing Address:
SUITE # 108
Provider Business Mailing Address City Name:
LOWELL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01854-2117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-710-4242
Provider Business Mailing Address Fax Number:
978-710-4202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
275 VARNUM AVE
Provider Second Line Business Practice Location Address:
SUITE # 108
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:
978-710-4242
Provider Business Practice Location Address Fax Number:
978-710-4202
Provider Enumeration Date:
04/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
SACHIN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-710-4242

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  228152 , 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)

  • Identifier: 117524 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 465583 . This is a "TUFTS & TUFTS MEDICARE PREFFERED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA67427 . This is a "HARVARD PILGRIM HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P00440617 . This is a "RAIL ROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2123649 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7667786 . This is a "ATENA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1023466 . This is a "CIGNA & HEALTHSOURCE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J40434 . This is a "BLUECROSS-BLUESHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 96037302 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com