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General NPI Number Information
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NPI Number | 1508200908
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Entity Type | Organization
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Legal Business Name | COHASSET HARBOR ADULT MEDICINE PRACTICE LLC
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 20 PARKINGWAY
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City | COHASSET
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State | MA
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Zip | 02025-1700
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Country | US
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Telephone | 781-383-9422
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Fax | 781-383-8024
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Provider Business Mailing Address
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Address Line | 20 PARKINGWAY
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City | COHASSET
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State | MA
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Zip | 02025-1700
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Country | US
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Telephone | 781-383-9422
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Fax | 781-383-8024
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Authorized Official
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Title or Position | MANAGER
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Name | ROGER POMPEO
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Credential | MD
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Telephone | 781-383-9422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 30135
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License Number State | MA
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