Provider Demographics
NPI:1578707162
Name:NORTHEAST MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:NORTHEAST MEDICAL GROUP, INC.
Other - Org Name:NORTHEAST MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SACHIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-710-4242
Mailing Address - Street 1:275 VARNUM AVENUE
Mailing Address - Street 2:SUITE # 108
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-2117
Mailing Address - Country:US
Mailing Address - Phone:978-710-4242
Mailing Address - Fax:978-710-4202
Practice Address - Street 1:275 VARNUM AVE
Practice Address - Street 2:SUITE # 108
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2141
Practice Address - Country:US
Practice Address - Phone:978-710-4242
Practice Address - Fax:978-710-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228152207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA117524OtherFALLON
MA465583OtherTUFTS & TUFTS MEDICARE PREFFERED
MAAA67427OtherHARVARD PILGRIM HEALTH CARE
P00440617OtherRAIL ROAD MEDICARE
MA2123649Medicaid
MA7667786OtherATENA
MA1023466OtherCIGNA & HEALTHSOURCE
MAJ40434OtherBLUECROSS-BLUESHIELD
MA96037302OtherNETWORK HEALTH
MAJ40434OtherBLUECROSS-BLUESHIELD