Healthcare Provider Details

I. General information

NPI: 1003988346
Provider Name (Legal Business Name): GL PEDIATRICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 BARTLETT ST SUITE 305
LOWELL MA
01852-1334
US

IV. Provider business mailing address

33 BARTLETT ST SUITE 305
LOWELL MA
01852-1334
US

V. Phone/Fax

Practice location:
  • Phone: 978-452-2200
  • Fax: 978-441-2550
Mailing address:
  • Phone: 978-452-2200
  • Fax: 978-441-2550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER BOUSIOS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 978-452-2200