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General NPI Number Information
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NPI Number | 1558623777
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Entity Type | Organization
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Legal Business Name | COGENT HEALTHCARE OF BROCKTON PC
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 06/13/2012
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Provider Practice Location Address
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Address Line | 85 SOUTH ST
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City | WARE
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State | MA
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Zip | 01082-1625
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Country | US
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Telephone | 615-377-5658
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Fax |
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Provider Business Mailing Address
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Address Line | 5410 MARYLAND WAY SUITE 300
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City | BRENTWOOD
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State | TN
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Zip | 37027-5064
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Country | US
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Telephone | 615-377-1669
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Fax | 615-246-4175
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Authorized Official
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Title or Position | OWNER
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Name | RONALD GREENO
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Credential | MD
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Telephone | 949-399-6003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist 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 | 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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