Provider Demographics
NPI:1881628535
Name:SOUTH SHORE WOMEN'S HEALTH, PC
Entity type:Organization
Organization Name:SOUTH SHORE WOMEN'S HEALTH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:EHRMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:339-201-4120
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:S WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190
Mailing Address - Country:US
Mailing Address - Phone:339-201-4120
Mailing Address - Fax:339-201-4122
Practice Address - Street 1:90 LIBBEY PARKWAY
Practice Address - Street 2:SUITE 105
Practice Address - City:S WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189
Practice Address - Country:US
Practice Address - Phone:339-201-4120
Practice Address - Fax:339-201-4122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM16666OtherBLUE CROSS/BLUE SHIELD
MAM16666OtherBCBS
MA614507OtherTUFTS
MA110091448A,B,C,DMedicaid
MAM16666OtherBLUE CROSS/BLUE SHIELD