Organization
SOUTH SUBURBAN PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE HOM MD (PRESIDENT)
(617) 773-7754
Entity
Organization
Contact information
Practice address
101 ADAMS STREET, QUINCY, MA 02169
(617) 773-7754
(617) 328-0957
Mailing address
101 ADAMS STREET, QUINCY, MA 02169
(617) 773-7754
(617) 328-0957
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
54474
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
667895
TUFTS
—
05
—
9785809
—
MA
01
—
M17310
BCBS
—
Enumeration date
07/10/2007
Last updated
07/10/2007
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