Healthcare Provider Details

I. General information

NPI: 1295803534
Provider Name (Legal Business Name): MONTU PATEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RIVERSIDE MEDICAL GROUP 275 VARNUM AVE STE 201
LOWELL MA
01854
US

IV. Provider business mailing address

RIVERSIDE MEDICAL GROUP 275 VARNUM AVE STE 201
LOWELL MA
01854
US

V. Phone/Fax

Practice location:
  • Phone: 978-452-9700
  • Fax: 978-441-6075
Mailing address:
  • Phone: 978-452-9700
  • Fax: 978-441-6075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number232230
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number232230
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number232230
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: