Healthcare Provider Details

I. General information

NPI: 1205248564
Provider Name (Legal Business Name): MR. V PECH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 WILDER ST
LOWELL MA
01851-1731
US

IV. Provider business mailing address

1 KHAO DANG PROVINCE
REFUGEE CAMP KHAO DANG
22210
TH

V. Phone/Fax

Practice location:
  • Phone: 978-452-4522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: