Healthcare Provider Details

I. General information

NPI: 1073572327
Provider Name (Legal Business Name): HAWTHORN ENDOSCOPY SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 FAUNCE CORNER ROAD
NORTH DARTMOUTH MA
02747-3717
US

IV. Provider business mailing address

PO BOX 3076
BOSTON MA
02241-3076
US

V. Phone/Fax

Practice location:
  • Phone: 508-996-3991
  • Fax:
Mailing address:
  • Phone: 508-996-3991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES GULAREK
Title or Position: CEO
Credential:
Phone: 508-996-3991