Provider Demographics
NPI:1700083433
Name:NEPHROLOGY ASSSOCIATES OF THE MERRIMACK VALLEY PC
Entity type:Organization
Organization Name:NEPHROLOGY ASSSOCIATES OF THE MERRIMACK VALLEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDUC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-453-1811
Mailing Address - Street 1:600 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-1699
Mailing Address - Country:US
Mailing Address - Phone:978-453-1811
Mailing Address - Fax:978-452-9111
Practice Address - Street 1:600 CLARK RD
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1699
Practice Address - Country:US
Practice Address - Phone:978-453-1811
Practice Address - Fax:978-452-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37818207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21106Medicare UPIN