Healthcare Provider Details

I. General information

NPI: 1043406416
Provider Name (Legal Business Name): CARLOS A DEL RIO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NASHUA RD SUITE 1
DRACUT MA
01826
US

IV. Provider business mailing address

505 NASHUA RD SUITE 1
DRACUT MA
01826
US

V. Phone/Fax

Practice location:
  • Phone: 978-957-9650
  • Fax: 978-957-9017
Mailing address:
  • Phone: 978-957-9650
  • Fax: 978-957-9017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number81822
License Number StateMA

VIII. Authorized Official

Name: MR. CARLOS ANGEL DEL RIO JR.
Title or Position: MD
Credential:
Phone: 978-957-9650