Healthcare Provider Details

I. General information

NPI: 1962486944
Provider Name (Legal Business Name): SOUTH SHORE OB-GYN HANOVER OB-GYN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 WEBSTER ST
HANOVER MA
02339-1200
US

IV. Provider business mailing address

135 WEBSTER ST
HANOVER MA
02339-1200
US

V. Phone/Fax

Practice location:
  • Phone: 781-878-7020
  • Fax: 781-871-3590
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GERALD J POULIOT
Title or Position: PRESIDENT
Credential:
Phone: 781-878-7020