Provider Demographics
NPI:1174783526
Name:LO, AMY R (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:LO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3799
Mailing Address - Country:US
Mailing Address - Phone:978-635-8700
Mailing Address - Fax:
Practice Address - Street 1:321 MAIN ST
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3799
Practice Address - Country:US
Practice Address - Phone:978-635-8700
Practice Address - Fax:978-635-8921
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA247460208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics