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General NPI Number Information
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NPI Number | 1659509164
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Entity Type | Organization
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Legal Business Name | EAST POND ENTERPRISES INC
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 04/24/2024
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Provider Practice Location Address
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Address Line | 68 N MAIN ST
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City | CARVER
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State | MA
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Zip | 02330
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Country | US
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Telephone | 508-747-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 68 N MAIN ST
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City | CARVER
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State | MA
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Zip | 02330-1128
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Country | US
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Telephone | 508-747-7246
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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. DAVID P GANNON
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Credential | MD
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Telephone | 508-747-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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