Healthcare Provider Details

I. General information

NPI: 1972596146
Provider Name (Legal Business Name): LGH PHYSICIAN ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 06/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 BARTLETT ST
LOWELL MA
01852-1322
US

IV. Provider business mailing address

1 HOSPITAL DRIVE 2ND FLOOR RESIDENCE BUILDING
LOWELL MA
01852-1322
US

V. Phone/Fax

Practice location:
  • Phone: 978-275-1913
  • Fax:
Mailing address:
  • Phone: 978-458-1411
  • Fax: 978-934-8368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUSAN GREEN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 978-788-7143