Healthcare Provider Details

I. General information

NPI: 1740920826
Provider Name (Legal Business Name): MARC POIRIER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

788 BOSTON RD
GROTON MA
01450-2281
US

IV. Provider business mailing address

788 BOSTON RD
GROTON MA
01450-2281
US

V. Phone/Fax

Practice location:
  • Phone: 978-449-0282
  • Fax:
Mailing address:
  • Phone: 978-449-0282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number1028804
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: