Basic Information
| Provider Information | |||||||||
| NPI: | 1467433359 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LGH WOMANHEALTH | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3 MEETING HOUSE RD | ||||||||
| Address2: | |||||||||
| City: | CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018242738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782561858 | ||||||||
| FaxNumber: | 9787887890 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 MEETINGHOUSE ROAD | ||||||||
| Address2: | |||||||||
| City: | CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018242454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782561858 | ||||||||
| FaxNumber: | 9787887890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 07/24/2012 | ||||||||
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| AuthorizedOfficialLastName: | GALVIN | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | MD PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9782561858 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | M17873 | 01 | MA | BCBS | OTHER | 9709801 | 05 | MA | MEDICAID |