Provider Demographics
NPI:1679341424
Name:IGC IV PLLC
Entity type:Organization
Organization Name:IGC IV PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:TILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-459-6737
Mailing Address - Street 1:41 WELLMAN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-5161
Mailing Address - Country:US
Mailing Address - Phone:978-459-6737
Mailing Address - Fax:855-818-1869
Practice Address - Street 1:41 WELLMAN ST STE 400
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-5161
Practice Address - Country:US
Practice Address - Phone:978-459-6737
Practice Address - Fax:855-818-1869
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATED GASTROENTEROLOGY CONSULTANTS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-12
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty