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General NPI Number Information
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NPI Number | 1205215373
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Entity Type | Organization
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Legal Business Name | MASS MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 05/22/2015
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 200 CENTRAL ST SUITE #2
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City | LOWELL
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State | MA
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Zip | 01852-2201
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Country | US
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Telephone | 978-446-7982
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Fax | 866-897-3951
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Provider Business Mailing Address
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Address Line | 200 CENTRAL ST UNIT 2
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City | LOWELL
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State | MA
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Zip | 01852-2201
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Country | US
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Telephone | 978-446-7982
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Fax | 866-897-3951
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Authorized Official
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Title or Position | MEMBER
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Name | HAMID REZA DANESH
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Credential | MD
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Telephone | 978-888-3147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 223435
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 223435
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License Number State | MA
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