Provider Demographics
NPI:1407802804
Name:GREATER LOWELL PET PC
Entity Type:Organization
Organization Name:GREATER LOWELL PET PC
Other - Org Name:NEW ENGLAND PET OF GREATER LOWELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-687-2321
Mailing Address - Street 1:354 MERRIMACK ST
Mailing Address - Street 2:ENTRANCE D
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1754
Mailing Address - Country:US
Mailing Address - Phone:978-687-8187
Mailing Address - Fax:978-687-8185
Practice Address - Street 1:295 VARNUM AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2134
Practice Address - Country:US
Practice Address - Phone:978-458-9872
Practice Address - Fax:978-458-9876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA67-0397261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
699024OtherTUFTS
3184313OtherAETNA
M18082OtherBLUE CROSS OF MA
0029226OtherNEIGHBORHOOD HEALTH
626417OtherHARVARD PILGRIM
MA9726730Medicaid
M18082OtherBLUE CROSS OF MA
MA9726730Medicaid