Healthcare Provider Details

I. General information

NPI: 1679536379
Provider Name (Legal Business Name): MARY GEALOW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 BARTLETT ST 305
LOWELL MA
01852-1334
US

IV. Provider business mailing address

2 STONEYBROOK CIR
ANDOVER MA
01810-6408
US

V. Phone/Fax

Practice location:
  • Phone: 978-452-2200
  • Fax:
Mailing address:
  • Phone: 978-689-4644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number156265
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: