Provider Demographics
NPI:1700156239
Name:MIDDLESEX GASTEROENTOLOGY PC
Entity Type:Organization
Organization Name:MIDDLESEX GASTEROENTOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:DEUARAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:975-429-2010
Mailing Address - Street 1:190 GROTON RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:AYER
Mailing Address - State:MA
Mailing Address - Zip Code:01432-3205
Mailing Address - Country:US
Mailing Address - Phone:978-772-3547
Mailing Address - Fax:978-772-0558
Practice Address - Street 1:190 GROTON RD
Practice Address - Street 2:190
Practice Address - City:AYER
Practice Address - State:MA
Practice Address - Zip Code:01432-3205
Practice Address - Country:US
Practice Address - Phone:978-772-3547
Practice Address - Fax:978-772-0558
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDDLESEX GASTROENTEROLOGY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy