Southboro Medical Group, INC

NPI #1164834750 in Southborough, Massachusetts

Provider Information

NPI Number: 1164834750
Entity Type: Organization
Organization Name: Southboro Medical Group, INC
Primary Specialty: Specialist
Enumeration Date: May 30, 2014
Last Updated: May 30, 2014

Practice Location

Address: 24 NEWTON ST
City: Southborough
State: Massachusetts
ZIP Code: 01772-1215
Phone: (508) 481-5500

Authorized Official

Name: HEATHER LABOSSIERE
Title: CREDENTIALING SPECIALIST
Phone: (508) 460-3297

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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