Organization
MODERN CARE MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE HARDIE (PRACTICE OPERATIONS MANAGER)
(978) 452-2000
Entity
Organization
Contact information
Practice address
1075 WESTFORD ST, SUITE 204, LOWELL, MA 01851-2716
(978) 452-2000
(978) 452-2001
Mailing address
1075 WESTFORD ST, SUITE 204, LOWELL, MA 01851-2716
(978) 452-2000
(978) 452-2001
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
243604
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0025815
MEDICARE GROUP PTAN
MA
01
—
002581601
MEDICARE PROVIDER PTAN
MA
Enumeration date
09/19/2011
Last updated
05/24/2012
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