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General NPI Number Information
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NPI Number | 1457669293
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Entity Type | Organization
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Legal Business Name | PLYMOUTH MEDAL GROUP INC
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 09/14/2010
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Provider Practice Location Address
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Address Line | 71 COMMERCIAL ST STE 307
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City | BOSTON
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State | MA
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Zip | 02109-1320
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Country | US
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Telephone | 774-330-9116
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Fax |
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Provider Business Mailing Address
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Address Line | 71 COMMERCIAL ST STE 307
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City | BOSTON
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State | MA
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Zip | 02109-1320
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RICHARD WHITE
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Credential |
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Telephone | 774-330-9116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 219192
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License Number State | MA
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