Healthcare Provider Details

I. General information

NPI: 1679734545
Provider Name (Legal Business Name): MASS LUNG & ALLERGY, PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL RD SUITE 2A
LEOMINSTER MA
01453-2253
US

IV. Provider business mailing address

PO BOX 726
LEOMINSTER MA
01453-0726
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateMA
# 5
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateMA

VIII. Authorized Official

Name: DR. PAYAM AGHASSI
Title or Position: OWNER PHYSICIAN
Credential: M.D.
Phone: 978-466-4549