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General NPI Number Information
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NPI Number | 1407802804
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Entity Type | Organization
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Legal Business Name | GREATER LOWELL PET PC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 2 HOSPITAL DR
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City | LOWELL
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State | MA
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Zip | 01852-1311
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Country | US
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Telephone | 978-458-9872
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Fax | 978-458-9876
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Provider Business Mailing Address
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Address Line | 35 NEW ENGLAND BUSINESS CENTER DR STE 103
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City | ANDOVER
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State | MA
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Zip | 01810-1080
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Country | US
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Telephone | 978-933-9302
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Fax | 789-337-8209
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Authorized Official
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Title or Position | CEO
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Name | MARK R TAYLOR
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Credential |
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Telephone | 978-933-9311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 67-0397
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License Number State | MA
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