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General NPI Number Information
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NPI Number | 1093701708
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Entity Type | Organization
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Legal Business Name | SOUTH SHORE PLASTIC SURGERY
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 03/09/2009
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Provider Practice Location Address
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Address Line | 2300 CROWN COLONY DR SUITE 101
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City | QUINCY
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State | MA
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Zip | 02169-0902
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Country | US
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Telephone | 617-786-7600
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Fax | 617-786-7616
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Provider Business Mailing Address
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Address Line | 2300 CROWN COLONY DR SUITE 101
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City | QUINCY
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State | MA
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Zip | 02169-0902
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Country | US
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Telephone | 617-786-7600
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Fax | 617-786-7616
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Authorized Official
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Title or Position | PRESIDENT
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Name | FOUAD J SAMAHA
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Credential | M.D.
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Telephone | 617-786-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 78298
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License Number State | MA
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