Healthcare Provider Details

I. General information

NPI: 1386040624
Provider Name (Legal Business Name): NEPHROLOGY ASSOCIATES OF THE MERRIMACK VALLEY CIRCLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 BARTLETT ST STE 108
LOWELL MA
01852-1334
US

IV. Provider business mailing address

33 BARTLETT ST STE 108
LOWELL MA
01852-1334
US

V. Phone/Fax

Practice location:
  • Phone: 978-453-1811
  • Fax: 978-452-9111
Mailing address:
  • Phone: 978-453-1811
  • Fax: 978-452-9111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number70684
License Number StateMA

VIII. Authorized Official

Name: DR. DOUGLAS E MESLER
Title or Position: PRESIDENT
Credential: MD
Phone: 978-453-1811