Healthcare Provider Details

I. General information

NPI: 1235321548
Provider Name (Legal Business Name): REKHA BAINS M.D., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 VARNUM AVE SUITE 108
LOWELL MA
01854-2141
US

IV. Provider business mailing address

275 VARNUM AVE SUITE 108
LOWELL MA
01854-2141
US

V. Phone/Fax

Practice location:
  • Phone: 978-452-1666
  • Fax: 978-452-1780
Mailing address:
  • Phone: 978-452-1666
  • Fax: 978-452-1780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number74928
License Number StateMA

VIII. Authorized Official

Name: DR. REKHA BAINS
Title or Position: DIRECTOR
Credential: M.D.
Phone: 978-452-4666