Provider Demographics
NPI:1316424591
Name:MIDDLESEX GASTEROENTOLOGY PC
Entity type:Organization
Organization Name:MIDDLESEX GASTEROENTOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVARAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-429-2010
Mailing Address - Street 1:45B DISCOVERY WAY
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-4482
Mailing Address - Country:US
Mailing Address - Phone:978-429-2010
Mailing Address - Fax:978-264-1935
Practice Address - Street 1:45B DISCOVERY WAY
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-4482
Practice Address - Country:US
Practice Address - Phone:978-429-2010
Practice Address - Fax:978-264-1935
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDDLESEX GASTEROENTOLOGY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty