Provider Demographics
NPI:1942667837
Name:MERRIMACK VALLEY PAIN MANAGEMENT PC
Entity Type:Organization
Organization Name:MERRIMACK VALLEY PAIN MANAGEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSTUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-685-2455
Mailing Address - Street 1:280 MERRIMACK ST.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843
Mailing Address - Country:US
Mailing Address - Phone:978-685-2455
Mailing Address - Fax:978-685-2959
Practice Address - Street 1:280 MERRIMACK ST.
Practice Address - Street 2:SUITE 103
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843
Practice Address - Country:US
Practice Address - Phone:978-685-2455
Practice Address - Fax:978-685-2459
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERRIMACK VALLEY PAIN MANAGEMENT PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213741207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty