Provider Demographics
NPI:1033130919
Name:MERRIMACK VALLEY GASTROENTEROLOGY, PC
Entity Type:Organization
Organization Name:MERRIMACK VALLEY GASTROENTEROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:MACMILLAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:978-521-3681
Mailing Address - Street 1:200 SUTTON ST STE 140
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-1651
Mailing Address - Country:US
Mailing Address - Phone:978-521-3681
Mailing Address - Fax:978-521-3682
Practice Address - Street 1:200 SUTTON ST STE 140
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-1651
Practice Address - Country:US
Practice Address - Phone:978-521-3681
Practice Address - Fax:978-521-3682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152953207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9735780Medicaid
MAM21545Medicare ID - Type Unspecified