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General NPI Number Information
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NPI Number | 1194270413
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Entity Type | Organization
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Legal Business Name | ST MARYS INTERNAL MEDICINE PC
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Dates
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Enumeration Date | 08/16/2016
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Last Update Date | 02/02/2017
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Provider Practice Location Address
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Address Line | 6 ESSEX CENTER DR SUITE 304
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City | PEABODY
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State | MA
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Zip | 01960-2904
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Country | US
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Telephone | 978-854-6376
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Fax |
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Provider Business Mailing Address
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Address Line | 6 ESSEX CENTER DR SUITE 304
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City | PEABODY
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State | MA
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Zip | 01960-2904
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Country | US
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Telephone | 978-854-6376
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUNGSIK HAHN
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Credential | MD
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Telephone | 508-265-3975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 236055
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License Number State | MA
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Taxonomy #2
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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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