1841739489 NPI number — LANDMARK MEDICAL OF MASSACHUSETTS PLLC

Table of content: (NPI 1841739489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841739489 NPI number — LANDMARK MEDICAL OF MASSACHUSETTS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LANDMARK MEDICAL OF MASSACHUSETTS PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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NPI Number Information

NPI Number:
1841739489
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7755 CENTER AVE
Provider Second Line Business Mailing Address:
STE 630
Provider Business Mailing Address City Name:
HUNTINGTON BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92647-3007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 COMPUTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTBOROUGH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01581-1760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
657-400-5180
Provider Business Practice Location Address Fax Number:
844-698-7227
Provider Enumeration Date:
02/15/2017

Additional Information

Authorized Official

Authorized Official Last Name:
DENNIS
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
657-237-2450

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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