Healthcare Provider Details

I. General information

NPI: 1881688323
Provider Name (Legal Business Name): LUNG SPECIALISTS OF MERRIMACK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 VARNUM AVE SUITE 203
LOWELL MA
01854-2109
US

IV. Provider business mailing address

275 VARNUM AVE SUITE 203
LOWELL MA
01854-2109
US

V. Phone/Fax

Practice location:
  • Phone: 978-934-9220
  • Fax: 978-453-7771
Mailing address:
  • Phone: 978-934-9220
  • Fax: 978-453-7771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DENIS Y LIN
Title or Position: TREASURER
Credential: MD
Phone: 978-934-9220