Provider Demographics
NPI:1073680831
Name:CARDIOLOGY ASSOCIATES OF GREATER LOWELL INC
Entity type:Organization
Organization Name:CARDIOLOGY ASSOCIATES OF GREATER LOWELL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEROLD
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-452-7000
Mailing Address - Street 1:33 BARTLETT STREET
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852
Mailing Address - Country:US
Mailing Address - Phone:978-452-7000
Mailing Address - Fax:978-458-2828
Practice Address - Street 1:33 BARTLETT STREET
Practice Address - Street 2:SUITE 206
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852
Practice Address - Country:US
Practice Address - Phone:978-452-7000
Practice Address - Fax:978-458-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM15276OtherBLUE SHIELD
MA9764771Medicaid
724395OtherTUFTS
M15276Medicare ID - Type Unspecified