Provider Demographics
NPI:1962652990
Name:MERRIMACK VALLEY PAIN MANAGEMENT ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:MERRIMACK VALLEY PAIN MANAGEMENT ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
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 STE 103
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1780
Mailing Address - Country:US
Mailing Address - Phone:978-685-2455
Mailing Address - Fax:978-685-2459
Practice Address - Street 1:280 MERRIMACK ST STE 103
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1780
Practice Address - Country:US
Practice Address - Phone:978-685-2455
Practice Address - Fax:978-685-2459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213741261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1962652990OtherTRICARE
MA614350100OtherTUFTS
MA614350100OtherACS
MA9744801Medicaid
MAAA132832OtherHEALTHCARE VALUE
NH30217445Medicaid
MAAA132832OtherHEALTH PLANS
MAM19676OtherBC/BS
MAAA132832OtherHARVARD
MA1881694180OtherBMC
MA1881694180OtherFALLON
MA1962652990OtherGIC UNICARE
MA9111315OtherAETNA