Provider Demographics
NPI:1851595136
Name:GREATER SUBURBAN HEALTH SERVICES
Entity Type:Organization
Organization Name:GREATER SUBURBAN HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:OHMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:508-333-5200
Mailing Address - Street 1:21 MAPLECREST DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-1243
Mailing Address - Country:US
Mailing Address - Phone:508-333-5200
Mailing Address - Fax:508-624-6264
Practice Address - Street 1:750 WASHINGTON ST
Practice Address - Street 2:NEMC BOX 30
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1526
Practice Address - Country:US
Practice Address - Phone:617-636-5333
Practice Address - Fax:617-633-4843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2015528Medicaid
MAB32075Medicare ID - Type Unspecified
MA2015528Medicaid