Healthcare Provider Details

I. General information

NPI: 1952695884
Provider Name (Legal Business Name): LGH MERRIMACK VALLEY CARDIOLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 RESEARCH PL
NORTH CHELMSFORD MA
01863-2412
US

IV. Provider business mailing address

14 RESEARCH PL
NORTH CHELMSFORD MA
01863-2412
US

V. Phone/Fax

Practice location:
  • Phone: 978-256-6607
  • Fax:
Mailing address:
  • Phone: 978-256-6607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUSAN GREEN
Title or Position: CFO
Credential:
Phone: 978-937-6201