Provider Demographics
NPI:1992845911
Name:MIDDLESEX GASTROENTEROLGY,P.C.
Entity Type:Organization
Organization Name:MIDDLESEX GASTROENTEROLGY,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEEANN
Authorized Official - Middle Name:C
Authorized Official - Last Name:IANNARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-429-2010
Mailing Address - Street 1:45B DISCOVERY WAY
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720
Mailing Address - Country:US
Mailing Address - Phone:978-429-2010
Mailing Address - Fax:978-264-1935
Practice Address - Street 1:45 DISCOVERY WAY # B
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-4482
Practice Address - Country:US
Practice Address - Phone:978-429-2010
Practice Address - Fax:978-264-1935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM15954Medicare ID - Type Unspecified