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General NPI Number Information
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NPI Number | 1053582031
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Entity Type | Organization
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Legal Business Name | PLYMOUTH BAY ORTHOPEDIC ASSOCIATES INC.
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 08/22/2017
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Provider Practice Location Address
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Address Line | 95 TREMONT ST SUITE 20
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City | DUXBURY
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State | MA
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Zip | 02332-4738
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Country | US
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Telephone | 781-934-7292
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Fax | 781-934-8112
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Provider Business Mailing Address
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Address Line | 95 TREMONT ST SUITE 1
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City | DUXBURY
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State | MA
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Zip | 02332-4738
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Country | US
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Telephone | 781-934-2400
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Fax | 781-934-8112
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Authorized Official
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Title or Position | OWNER
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Name | R SCOTT OLIVER
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Credential | MD
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Telephone | 781-934-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 259
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License Number State | MA
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