Healthcare Provider Details

I. General information

NPI: 1154556496
Provider Name (Legal Business Name): JOSE DAVID PONCE RIOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 03/29/2026
Certification Date: 03/29/2026
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: 978-937-6000
  • Fax:
Mailing address:
  • Phone: 978-937-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number251391
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number251391
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: