Provider Demographics
NPI:1114914868
Name:MERRIMACK VALLEY MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:MERRIMACK VALLEY MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:978-725-4822
Mailing Address - Street 1:PO BOX 3160
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-0803
Mailing Address - Country:US
Mailing Address - Phone:978-289-1188
Mailing Address - Fax:978-474-8845
Practice Address - Street 1:421 MERRIMACK ST
Practice Address - Street 2:SUITE 201
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5803
Practice Address - Country:US
Practice Address - Phone:978-725-4822
Practice Address - Fax:978-725-5277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155341207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2301962OtherAETNA US HEALTH
MA3208621Medicaid
MA50493OtherMATTHEW THORNTON
MA9593735010OtherCIGNA
MA504290OtherCIGNA HEALTHSOURCE
MA155341OtherTUFTS
MA69499OtherHARVARD PILGRIM
MA2301962OtherUS HEALTH
MA49241OtherFALLON
MA504290OtherHEALTH SOURCE
MAM18024OtherBLUE CROSS BLUE SHIELD
MA3208621Medicaid