Provider Demographics
NPI:1215661780
Name:TVCG STE PLLC
Entity type:Organization
Organization Name:TVCG STE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-775-1984
Mailing Address - Street 1:981 WORCESTER ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-3716
Mailing Address - Country:US
Mailing Address - Phone:781-304-8838
Mailing Address - Fax:
Practice Address - Street 1:1115 WESTFORD ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-2853
Practice Address - Country:US
Practice Address - Phone:351-221-7080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-12
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty