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General NPI Number Information
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NPI Number | 1962652990
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Entity Type | Organization
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Legal Business Name | MERRIMACK VALLEY PAIN MANAGEMENT ASSOCIATES, P.C.
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Dates
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Enumeration Date | 09/26/2008
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Last Update Date | 01/31/2018
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Provider Practice Location Address
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Address Line | 280 MERRIMACK ST STE 103
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City | LAWRENCE
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State | MA
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Zip | 01843-1780
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Country | US
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Telephone | 978-685-2455
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Fax | 978-685-2459
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Provider Business Mailing Address
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Address Line | 280 MERRIMACK ST STE 103
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City | LAWRENCE
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State | MA
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Zip | 01843-1780
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Country | US
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Telephone | 978-685-2455
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Fax | 978-685-2459
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAMI RUSTUM
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Credential | MD
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Telephone | 978-685-2455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 213741
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License Number State | MA
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