Healthcare Provider Details

I. General information

NPI: 1548392020
Provider Name (Legal Business Name): SAMUEL HONG POON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: HONG WAH SAMUEL POON M.D.

II. Dates (important events)

Enumeration Date: 03/11/2007
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 THOMPSON RD HARRINGTON PHYSICIAN SERVICES
WEBSTER MA
01570-1509
US

IV. Provider business mailing address

PO BOX 40 HARRINGTON MEMORIAL HOSPITAL
SOUTHBRIDGE MA
01550-0040
US

V. Phone/Fax

Practice location:
  • Phone: 508-943-5132
  • Fax: 508-943-5209
Mailing address:
  • Phone: 508-909-7799
  • Fax: 508-764-2432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP00470
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number231935
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number13006
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: