Tewksbury was first settled in 1637 and was officially incorporated in 1734 from Billerica. Like Tewksbury Township, New Jersey, it is named after the town of Tewkesbury, England. Tewksbury, Massachusetts and Tewkesbury, England kept connected through a local committee called the twinning committee. One of the oldest sections of town is the area around the Shawsheen River. This is where the Shawshin tribe settled, allowing them access to a great food source through fishing in the river. Tewksbury was also known for a historic visit by President Andrew Jackson, stopping off at local watering hole, Brown's Tavern.

On July 24, 1857, a powerful tornado swept through Tewksbury. The tempest began at Round Pond as a small water spout, and traveled west and then southeast to the Shawsheen River. It dissipated at North Wilmington. Several corn fields and orchards were severely damaged, with one residence having its roof blown off. The tornado was powerful enough to flatten barns and sheds, pull up large trees by their roots, and sweep away and kill a team of oxen. Due to the sparse population, and homes located above the valley floor, no one was killed, and only a few people were injured.

According to the United States Census Bureau, the town has a total area of 21.1 square miles (55 km²), of which 20.7 square miles (54 km²) is land and 0.3 square miles (0.78 km²), or 1.61%, is water.

The Merrimack River forms part of the northern boundary of Tewksbury, and the Shawsheen River runs through the southern end of town as well.

Tewksbury is in Greater Lowell. The town is located about 19 miles (31 km) north-northwest of Boston along I-93 and I-495 (Boston's outer beltway). Tewksbury is bordered by the city of Lowell to the northwest, Dracut to the north (unreachable across the Merrimack), Andover to the northeast, Wilmington to the southeast, and Billerica to the southwest. Tewksbury also meets the town of Chelmsford at a point in the middle of the Concord River along with Lowell and Billerica.

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