Healthcare Provider Details

I. General information

NPI: 1477531358
Provider Name (Legal Business Name): JAMES MATTHEW KOOMEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 SANDWICH ST C/O CATHY GREY
PLYMOUTH MA
02360-2183
US

IV. Provider business mailing address

275 SANDWICH ST C/O CATHY GREY
PLYMOUTH MA
02360-2183
US

V. Phone/Fax

Practice location:
  • Phone: 508-830-2390
  • Fax: 508-830-2399
Mailing address:
  • Phone: 508-830-2390
  • Fax: 508-830-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number155230
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: