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Organization
SIGNATURE HEALTHCARE MEDICAL GROUP
Active
Organization
SIGNATURE HEALTHCARE MEDICAL GROUP
Active
Parent organization
SIGNATURE HEALTHCARE CORPORATION
Other names
Signature Medical Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
SIGNATURE HEALTHCARE CORPORATION
Authorized official
MR. EUGENE WALLACE (CFO)
(508) 941-7007
Entity
Organization
Contact information
Practice address
680 CENTRE ST, BROCKTON, MA 02302-3308
(508) 941-7007
(508) 941-6338
Mailing address
680 CENTRE ST, BROCKTON, MA 02302-3308
(508) 941-7007
(508) 941-6338
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207RN0300X
Nephrology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208000000X
Pediatrics Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208600000X
Surgery Physician
—
—
208M00000X
Hospitalist Physician
—
—
Other
Enumeration date
04/07/2009
Last updated
04/07/2009
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