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NPI Code Detail

MEDICARE: SOUTH SHORE OB-GYN HANOVER OB-GYN INC

MEDICARE: SOUTH SHORE OB-GYN HANOVER OB-GYN INC
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
1207V00000XObstetrics & Gynecology Physician

General Provider Information

NPI Number : 1962486944
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH SHORE OB-GYN HANOVER OB-GYN INC
Provider Business Mailing Address
First Line : 135 WEBSTER ST
Second Line :
City : HANOVER
State : MA
Zip : 02339-1200
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 135 WEBSTER ST
Second Line :
City : HANOVER
State : MA
Zip : 02339-1200
Country : US
Telephone Number : 781-878-7020
Fax Number : 781-871-3590
Authorized Official
Title or Position : PRESIDENT
Name : DR. GERALD J POULIOT
Credential :
Telephone Number : 781-878-7020
Provider Enumeration Date : 12/02/2005
Last Update Date : 10/06/2015

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Directions to “SOUTH SHORE OB-GYN HANOVER OB-GYN INC ” Practice Location

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