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NPI Code Detail

MEDICARE: MIDDLESEX GASTROENTEROLGY,P.C.

MEDICARE: MIDDLESEX GASTROENTEROLGY,P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistMA

General Provider Information

NPI Number : 1992845911
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIDDLESEX GASTROENTEROLGY,P.C.
Provider Business Mailing Address
First Line : 45B DISCOVERY WAY
Second Line :
City : ACTON
State : MA
Zip : 01720
Country : US
Telephone Number : 978-429-2010
Fax Number : 978-264-1935
Provider Business Practice Location Address
First Line : 45 DISCOVERY WAY # B
Second Line :
City : ACTON
State : MA
Zip : 01720-4482
Country : US
Telephone Number : 978-429-2010
Fax Number : 978-264-1935
Authorized Official
Title or Position : OFFICE MANAGER
Name : LEEANN C IANNARELLI
Credential :
Telephone Number : 978-429-2010
Provider Enumeration Date : 02/07/2007
Last Update Date : 07/21/2022

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