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General NPI Number Information
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NPI Number | 1265425185
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Entity Type | Individual
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Provider Name | CHERYL A ENNIS M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/25/2005
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 295 VARNUM AVE LOWELL GENERAL HOSPITAL
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City | LOWELL
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State | MA
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Zip | 01854
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Country | US
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Telephone | 978-937-6889
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Fax |
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Provider Business Mailing Address
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Address Line | 110A CONCORD ST
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City | NASHUA
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State | NH
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Zip | 03064-1704
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Country | US
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Telephone | 603-889-3249
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 10783
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License Number State | NH
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