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General NPI Number Information
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NPI Number | 1912082694
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH OB-GYN, PC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 10/01/2007
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Provider Practice Location Address
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Address Line | 1 BROOKLINE PL SUITE 305
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City | BROOKLINE
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State | MA
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Zip | 02445-7224
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Country | US
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Telephone | 617-732-1510
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Fax | 617-732-0986
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Provider Business Mailing Address
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Address Line | 1 BROOKLINE PL SUITE 305
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City | BROOKLINE
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State | MA
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Zip | 02445-7224
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Country | US
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Telephone | 617-732-1510
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Fax | 617-732-0986
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Authorized Official
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Title or Position | PRESIDENT
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Name | DERNA DEMAGGIO
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Credential | MD
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Telephone | 617-732-1510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 79073
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License Number State | MA
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