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General NPI Number Information
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NPI Number | 1558150052
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Entity Type | Organization
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Legal Business Name | INTEGRATED GASTROENTEROLOGY CONSULTANTS PC
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Dates
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Enumeration Date | 05/02/2025
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 300 FEDERAL ST # 103B
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City | ANDOVER
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State | MA
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Zip | 01810-1038
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Country | US
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Telephone | 978-459-6737
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Fax |
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Provider Business Mailing Address
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Address Line | 41 WELLMAN ST # 400
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City | LOWELL
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State | MA
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Zip | 01851-5161
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Country | US
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Telephone | 978-459-6737
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RICHARD S. TILSON
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Credential | MD
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Telephone | 978-459-6737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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