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General NPI Number Information
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NPI Number | 1881023869
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Entity Type | Organization
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Legal Business Name | RIVERSIDE SURGICAL OF LOWELL PC
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Dates
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Enumeration Date | 11/11/2013
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Last Update Date | 11/11/2013
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Provider Practice Location Address
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Address Line | 33 BARTLETT ST SUITE 503
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City | LOWELL
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State | MA
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Zip | 01852-1334
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Country | US
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Telephone | 978-458-4300
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Fax | 978-458-4311
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Provider Business Mailing Address
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Address Line | 33 BARTLETT ST SUITE 503
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City | LOWELL
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State | MA
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Zip | 01852-1334
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Country | US
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Telephone | 978-458-4300
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Fax | 978-458-4311
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WASSIM MAZRAANY
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Credential | MD
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Telephone | 978-458-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2358523
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License Number State | MA
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