Healthcare Provider Details

I. General information

NPI: 1811105539
Provider Name (Legal Business Name): BASS RIVER PEDIATRIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 STATION AVE
SOUTH YARMOUTH MA
02664-1863
US

IV. Provider business mailing address

237 STATION AVE
SOUTH YARMOUTH MA
02664-1863
US

V. Phone/Fax

Practice location:
  • Phone: 508-394-2116
  • Fax: 508-760-1919
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH COLMER
Title or Position: MD
Credential:
Phone: 508-394-2116