Basic Information
| Provider Information | |||||||||
| NPI: | 1114927282 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOWELL ANESTHESIOLOGY SERVICE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 EAST ST | ||||||||
| Address2: | STE 1400 | ||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018444500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786894601 | ||||||||
| FaxNumber: | 9786893096 | ||||||||
| Practice Location | |||||||||
| Address1: | 60 EAST ST | ||||||||
| Address2: | STE 1400 | ||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018444500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786894601 | ||||||||
| FaxNumber: | 9786893096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | THAVASEELAN | ||||||||
| AuthorizedOfficialFirstName: | DORAIRATU | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9786894601 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 600165 | 01 | TUFT | OTHER | M11362 | 01 | MA | BCBS | OTHER | CA3406 | 01 | RR MEDICARE | OTHER | 30004048 | 05 | NH | MEDICAID | 9703462 | 05 | MA | MEDICAID |