Provider Demographics
NPI:1003988346
Name:GREATER LOWELL PEDIATRICS, INC.
Entity Type:Organization
Organization Name:GREATER LOWELL PEDIATRICS, INC.
Other - Org Name:GREATER LOWELLPEDIATRICS,INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUSIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-452-2200
Mailing Address - Street 1:33 BARTLETT ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1334
Mailing Address - Country:US
Mailing Address - Phone:978-452-2200
Mailing Address - Fax:978-441-2550
Practice Address - Street 1:33 BARTLETT ST
Practice Address - Street 2:SUITE 305
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1334
Practice Address - Country:US
Practice Address - Phone:978-452-2200
Practice Address - Fax:978-441-2550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM16979OtherBYBS
MA110072646AMedicaid
MA9783687Medicaid