Provider Demographics
NPI:1235547084
Name:MASS LUNG & ALLERGY PC
Entity Type:Organization
Organization Name:MASS LUNG & ALLERGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPHA
Authorized Official - Phone:978-466-2692
Mailing Address - Street 1:100 HOSPITAL RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2253
Mailing Address - Country:US
Mailing Address - Phone:978-468-2692
Mailing Address - Fax:978-466-2548
Practice Address - Street 1:131 OLD RD TO 9 CORNER
Practice Address - Street 2:SUITE 410
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-341-8660
Practice Address - Fax:978-341-8658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216020207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty