Healthcare Provider Details

I. General information

NPI: 1285608398
Provider Name (Legal Business Name): CARLOS ANGEL DEL RIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NASHUA RD SUITE 1
DRACUT MA
01826-1929
US

IV. Provider business mailing address

505 NASHUA RD SUITE 1
DRACUT MA
01826-1929
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:
Title or Position:
Credential:
Phone: