Provider Demographics
NPI:1982693891
Name:MERRIMACK VALLEY PEDIATRIC ASSOCIATES
Entity type:Organization
Organization Name:MERRIMACK VALLEY PEDIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-667-9611
Mailing Address - Street 1:221 BOSTON RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01862-2321
Mailing Address - Country:US
Mailing Address - Phone:978-667-9611
Mailing Address - Fax:978-667-3949
Practice Address - Street 1:221 BOSTON RD
Practice Address - Street 2:SUITE 8
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01862-2321
Practice Address - Country:US
Practice Address - Phone:978-667-9611
Practice Address - Fax:978-667-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty