Basic Information
| Provider Information | |||||||||
| NPI: | 1891761862 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GASTROENTEROLOGY AFFILIATES OF SOUTHEASTERN MASSACHUSETTS, PC | ||||||||
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| OtherOrganizationName: | RHEUMATOLOGY & GASTROENTEROLOGY ASSOC PC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 PEARL ST | ||||||||
| Address2: | SUITE 1200 | ||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023012864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085883174 | ||||||||
| FaxNumber: | 5085883179 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 PEARL ST | ||||||||
| Address2: | SUITE 1200 | ||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023012864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085883174 | ||||||||
| FaxNumber: | 5085883179 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 05/16/2011 | ||||||||
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| AuthorizedOfficialLastName: | SOLOMAN | ||||||||
| AuthorizedOfficialFirstName: | JOEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT OF CORPORATION | ||||||||
| AuthorizedOfficialTelephone: | 5085883174 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.