Provider Demographics
NPI:1629793591
Name:SOUTH SHORE ORTHOPEDICS, LLC
Entity Type:Organization
Organization Name:SOUTH SHORE ORTHOPEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-337-5555
Mailing Address - Street 1:2 POND PARK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4354
Mailing Address - Country:US
Mailing Address - Phone:781-337-5555
Mailing Address - Fax:
Practice Address - Street 1:360 BROCKTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:MA
Practice Address - Zip Code:02351-2186
Practice Address - Country:US
Practice Address - Phone:781-337-5555
Practice Address - Fax:781-335-6047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty