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General NPI Number Information
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NPI Number | 1003674854
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Entity Type | Organization
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Legal Business Name | GOLDEN YEARS GERIATRIC MEDICINE
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Dates
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Enumeration Date | 03/07/2024
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 11 CASCADE AVE
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City | LOWELL
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State | MA
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Zip | 01851-1613
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Country | US
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Telephone | 978-987-1170
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Fax |
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Provider Business Mailing Address
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Address Line | 11 CASCADE AVE
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City | LOWELL
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State | MA
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Zip | 01851-1613
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Country | US
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Telephone | 978-987-1170
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Fax |
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Authorized Official
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Title or Position | NP
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Name | SUSAN JAMIESON
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Credential | NP
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Telephone | 857-225-1868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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