1447211503 NPI number — GREATER LOWELL FAMILY PRACTICE PC

Table of content: (NPI 1447211503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447211503 NPI number — GREATER LOWELL FAMILY PRACTICE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER LOWELL FAMILY PRACTICE PC
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:
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:
1447211503
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 CLARK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEWKSBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01876-1699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-851-4141
Provider Business Mailing Address Fax Number:
978-788-7911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 CLARK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEWKSBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01876-1699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-453-8446
Provider Business Practice Location Address Fax Number:
978-453-0621
Provider Enumeration Date:
03/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEWTON
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
978-851-4141

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 47300 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9785329 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH0509 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M17209 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0020561 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 103269000 . This is a "FEDERAL WORKERS COMP." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 38888 . This is a "FALLON COMMUNITY HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 668793 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0101333 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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