Provider Demographics
NPI:1124337175
Name:MERRIMACK MEDICAL & WALK IN CENTER, LLC
Entity type:Organization
Organization Name:MERRIMACK MEDICAL & WALK IN CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FARZAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-688-3100
Mailing Address - Street 1:25 MARSTON ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2310
Mailing Address - Country:US
Mailing Address - Phone:978-688-3100
Mailing Address - Fax:
Practice Address - Street 1:25 MARSTON ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2310
Practice Address - Country:US
Practice Address - Phone:978-688-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-24
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty