Provider Demographics
NPI:1447201140
Name:LOTUS MED LLC
Entity Type:Organization
Organization Name:LOTUS MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAIDU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-772-1277
Mailing Address - Street 1:190 GROTON ROAD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:AYER
Mailing Address - State:MA
Mailing Address - Zip Code:01432
Mailing Address - Country:US
Mailing Address - Phone:978-772-1277
Mailing Address - Fax:978-772-1577
Practice Address - Street 1:190 GROTON RD
Practice Address - Street 2:SUITE 290
Practice Address - City:AYER
Practice Address - State:MA
Practice Address - Zip Code:01432-1124
Practice Address - Country:US
Practice Address - Phone:978-772-1277
Practice Address - Fax:978-772-1577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156202302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3204928Medicaid
H09311Medicare UPIN
MA3204928Medicaid