Healthcare Provider Details

I. General information

NPI: 1982873428
Provider Name (Legal Business Name): DRS. MONTMINY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ARCAND DR
LOWELL MA
01852-1026
US

IV. Provider business mailing address

75 ARCAND DR
LOWELL MA
01852-1026
US

V. Phone/Fax

Practice location:
  • Phone: 978-459-0702
  • Fax:
Mailing address:
  • Phone: 978-459-0702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number2264
License Number StateMA

VIII. Authorized Official

Name: MR. GEORGE ROBERT MONTMINY
Title or Position: DOCTOR
Credential: O.D.
Phone: 978-459-0702