| Organization Name: | COHASSET HARBOR ADULT MEDICINE PRACTICE LLC |
| NPI Number: | 1508200908 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROGER POMPEO (MANAGER) |
| Mailing Address: | 20 Parkingway Cohasset |
| State: | MA US |
| Postal Code: | 020251700 |
| Phone Number: | 7813839422 |
| Fax Number: | 7813838024 |
| NPI Enumeration Date: | 04/29/2013 |
| NPI Last Update Date: | 04/29/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | 30135 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |