Healthcare Provider Details

I. General information

NPI: 1265405575
Provider Name (Legal Business Name): SNEHLATA V DAVE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 MERRIMACK STREET LOWELL COMMUNITY HEALTH CENTER
LOWELL MA
01854
US

IV. Provider business mailing address

585 597 MERRIMACK STREET LOWELL COMMUNITY HEALTH CENTER
LOWELL MA
01854
US

V. Phone/Fax

Practice location:
  • Phone: 978-937-9700
  • Fax: 978-446-9830
Mailing address:
  • Phone: 978-937-9700
  • Fax: 978-446-9830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number56557
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: