Healthcare Provider Details

I. General information

NPI: 1831122159
Provider Name (Legal Business Name): SOUTH SHORE ENDOSCOPY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 WASHINGTON ST
BRAINTREE MA
02184-5778
US

IV. Provider business mailing address

77 ACCORD PARK DR BLDG D4 - CREDENTIALING
NORWELL MA
02061-1623
US

V. Phone/Fax

Practice location:
  • Phone: 781-849-9577
  • Fax: 781-849-9581
Mailing address:
  • Phone: 781-952-1526
  • Fax: 781-878-8627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number StateMA

VIII. Authorized Official

Name: DR. PETER GRAPE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 781-952-1249