Basic Information
| Provider Information | |||||||||
| NPI: | 1215384672 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH SHORE HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44 HARVEST LN | ||||||||
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| City: | MILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064611705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036239992 | ||||||||
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| Practice Location | |||||||||
| Address1: | 55 FOGG RD | ||||||||
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| City: | SOUTH WEYMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021902432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7816248000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2016 | ||||||||
| LastUpdateDate: | 05/16/2016 | ||||||||
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| AuthorizedOfficialLastName: | CRAMER | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SURGICAL PHYSICIAN ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 2036239992 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.