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General NPI Number Information
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NPI Number | 1215661780
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Entity Type | Organization
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Legal Business Name | TVCG STE PLLC
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Dates
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Enumeration Date | 07/12/2022
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | 1115 WESTFORD ST
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City | LOWELL
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State | MA
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Zip | 01851-2853
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Country | US
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Telephone | 351-221-7080
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Fax |
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Provider Business Mailing Address
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Address Line | 981 WORCESTER ST STE 2A
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City | WELLESLEY
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State | MA
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Zip | 02482-3716
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Country | US
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Telephone | 781-304-8838
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL GORIN
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Credential | MD
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Telephone | 508-775-1984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology 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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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