Healthcare Provider Details

I. General information

NPI: 1326305368
Provider Name (Legal Business Name): MASS LUNG & ALLERGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ERDMAN WAY SUITE 2S
LEOMINSTER MA
01453-1804
US

IV. Provider business mailing address

50 MEMORIAL DRIVE SUITE 113
LEOMINSTER MA
01453
US

V. Phone/Fax

Practice location:
  • Phone: 978-728-4641
  • Fax: 978-728-1382
Mailing address:
  • Phone: 978-466-2692
  • Fax: 978-466-4754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number StateMA

VIII. Authorized Official

Name: PAYAM AGHASSI
Title or Position: OWNER-PHYSICIAN
Credential: M.D.
Phone: 978-728-4641