Provider Demographics
NPI:1356324057
Name:PLYMOUTH OB-GYN ASSOCIATES INC
Entity Type:Organization
Organization Name:PLYMOUTH OB-GYN ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORSINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-746-1434
Mailing Address - Street 1:101 LONG POND ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360
Mailing Address - Country:US
Mailing Address - Phone:508-746-1434
Mailing Address - Fax:508-746-2209
Practice Address - Street 1:101 LONG POND ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360
Practice Address - Country:US
Practice Address - Phone:508-746-1434
Practice Address - Fax:508-746-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76977207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3119629Medicaid
F64507Medicare UPIN
MA3119629Medicaid
M12620Medicare ID - Type Unspecified