Healthcare Provider Details

I. General information

NPI: 1053616557
Provider Name (Legal Business Name): SURGICAL WEIGHT LOSS SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2011
Last Update Date: 10/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 UNION ST
EAST WALPOLE MA
02032-1037
US

IV. Provider business mailing address

278 UNION ST
EAST WALPOLE MA
02032-1037
US

V. Phone/Fax

Practice location:
  • Phone: 508-668-4400
  • Fax: 508-668-4420
Mailing address:
  • Phone: 508-668-4400
  • Fax: 508-664-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ADAM GLASGOW
Title or Position: DIRECTOR
Credential: MD
Phone: 508-668-4400