Healthcare Provider Details

I. General information

NPI: 1962979385
Provider Name (Legal Business Name): MARINA DAVOS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
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 TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: