Provider Demographics
NPI:1720388952
Name:SOUTH SHORE MIDWIFERY & GYNECOLOGY, LLC
Entity Type:Organization
Organization Name:SOUTH SHORE MIDWIFERY & GYNECOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:G
Authorized Official - Last Name:DENSMORE
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:781-871-7377
Mailing Address - Street 1:2100 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1657
Mailing Address - Country:US
Mailing Address - Phone:781-871-7377
Mailing Address - Fax:781-871-3996
Practice Address - Street 1:2100 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1657
Practice Address - Country:US
Practice Address - Phone:781-871-7377
Practice Address - Fax:781-871-3996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN199200367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty