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General NPI Number Information
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NPI Number | 1114914868
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Entity Type | Organization
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Legal Business Name | MERRIMACK VALLEY MEDICAL ASSOCIATES, PC
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 421 MERRIMACK ST SUITE 201
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City | METHUEN
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State | MA
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Zip | 01844-5803
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Country | US
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Telephone | 978-725-4822
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Fax | 978-725-5277
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Provider Business Mailing Address
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Address Line | PO BOX 3160
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City | ANDOVER
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State | MA
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Zip | 01810-0803
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Country | US
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Telephone | 978-289-1188
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Fax | 978-474-8845
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Authorized Official
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Title or Position | OWNER
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Name | DR. LEO WILLIAM LANE
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Credential | D.O.
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Telephone | 978-725-4822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 155341
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License Number State | MA
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