Provider Demographics
NPI:1962486944
Name:SOUTH SHORE OB-GYN HANOVER OB-GYN INC
Entity Type:Organization
Organization Name:SOUTH SHORE OB-GYN HANOVER OB-GYN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:POULIOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-878-7020
Mailing Address - Street 1:135 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:135 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1200
Practice Address - Country:US
Practice Address - Phone:781-878-7020
Practice Address - Fax:781-871-3590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty