MEDICARE: SURGICAL ASSOC OF MILFORD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1629185244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL ASSOC OF MILFORD PC

Provider Business Mailing Address
First Line	:	22 ASYLUM STREET
Second Line	:
City	:	MILFORD
State	:	MA
Zip	:	01757-2203
Country	:	US
Telephone Number	:	508-473-7221
Fax Number	:	507-478-1943

Provider Business Practice Location Address
First Line	:	22 ASYLUM STREET
Second Line	:
City	:	MILFORD
State	:	MA
Zip	:	01757-2203
Country	:	US
Telephone Number	:	508-473-7221
Fax Number	:	508-478-1943

Authorized Official
Title or Position	:	OWNER
Name	:	LUIGI QUERUSIO
Credential	:	MD
Telephone Number	:	508-473-7221

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	08/22/2020

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