Provider Demographics
NPI:1558150052
Name:INTEGRATED GASTROENTEROLOGY CONSULTANTS PC
Entity type:Organization
Organization Name:INTEGRATED GASTROENTEROLOGY CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:TILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-459-6737
Mailing Address - Street 1:41 WELLMAN ST # 400
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-5161
Mailing Address - Country:US
Mailing Address - Phone:978-459-6737
Mailing Address - Fax:
Practice Address - Street 1:300 FEDERAL ST # 103B
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-1038
Practice Address - Country:US
Practice Address - Phone:978-459-6737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-02
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty