Healthcare Provider Details

I. General information

NPI: 1700083433
Provider Name (Legal Business Name): NEPHROLOGY ASSSOCIATES OF THE MERRIMACK VALLEY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CLARK RD
TEWKSBURY MA
01876-1699
US

IV. Provider business mailing address

600 CLARK RD
TEWKSBURY MA
01876-1699
US

V. Phone/Fax

Practice location:
  • Phone: 978-453-1811
  • Fax: 978-452-9111
Mailing address:
  • Phone: 978-453-1811
  • Fax: 978-452-9111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number37818
License Number StateMA

VIII. Authorized Official

Name: SARAH LEDUC
Title or Position: PRACTICE MANAGER
Credential:
Phone: 978-453-1811