Basic Information
| Provider Information | |||||||||
| NPI: | 1881669398 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VASCULAR ASSOCIATES OF THE MERRIMACK VALLEY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2200 | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030314200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036739411 | ||||||||
| FaxNumber: | 6036739899 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 RESEARCH PL | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | NORTH CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018632439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784536900 | ||||||||
| FaxNumber: | 9784536905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2006 | ||||||||
| LastUpdateDate: | 04/01/2014 | ||||||||
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| AuthorizedOfficialLastName: | BURKE | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9784536900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | M17112 | 01 | MA | BCBS OF MASS | OTHER | 0013994 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | 668785 | 01 | TUFTS HEALTH PLAN | OTHER | 9708189 | 05 | MA | MEDICAID | 37664 | 01 | FALLON COMMUNITH HEALTH | OTHER |