Healthcare Provider Details

I. General information

NPI: 1952349953
Provider Name (Legal Business Name): MERRIMACK VALLEY PATHOLOGY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 VARNUM AVE
LOWELL MA
01854-2134
US

IV. Provider business mailing address

295 VARNUM AVE
LOWELL MA
01854-2134
US

V. Phone/Fax

Practice location:
  • Phone: 978-937-6341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number StateMA

VIII. Authorized Official

Name: DR. PATRICIA DEVINE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 978-937-6341