=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538701776
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEPSC-LOWELL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2019
-----------------------------------------------------
Last Update Date | 06/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 VILLAGE SQUARE
-----------------------------------------------------
City | CHELMSFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-942-4835
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35 UNITED DR STE 102
-----------------------------------------------------
City | WEST BRIDGEWATER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02379-1056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-238-8646
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MD
-----------------------------------------------------
Name | LOREEN ALI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 978-888-1889
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0122X
-----------------------------------------------------
Taxonomy Name | Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------