Healthcare Provider Details

I. General information

NPI: 1417918822
Provider Name (Legal Business Name): LGH PHYSICIAN ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GENERAL ST
LAWRENCE MA
01841-2961
US

IV. Provider business mailing address

38 PROSPECT ST
LAWRENCE MA
01841-2819
US

V. Phone/Fax

Practice location:
  • Phone: 978-683-4000
  • Fax: 978-946-8206
Mailing address:
  • Phone: 978-946-8330
  • Fax: 978-946-8340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number2099
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number145193
License Number StateMA

VIII. Authorized Official

Name: MS. DEBORAH J. WILSON
Title or Position: SENIOR VP/CFO
Credential:
Phone: 978-683-4000