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General NPI Number Information
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NPI Number | 1174700421
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Entity Type | Organization
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Legal Business Name | DIGESTIVE DISEASE ASSOCIATES PC
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 11/15/2016
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Provider Practice Location Address
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Address Line | 47 OBERY ST STE 201
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City | PLYMOUTH
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State | MA
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Zip | 02360-2230
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Country | US
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Telephone | 508-747-1560
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Fax | 508-747-5155
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Provider Business Mailing Address
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Address Line | 47 OBERY ST STE 201
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City | PLYMOUTH
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State | MA
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Zip | 02360
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Country | US
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Telephone | 508-747-1560
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Fax | 508-747-5155
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JONATHAN M RUSSO
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Credential | MD
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Telephone | 508-747-1560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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