Provider Demographics
NPI:1053591297
Name:PLYMOUTH BAY UROLOGY SPECIALISTS, P.C.
Entity type:Organization
Organization Name:PLYMOUTH BAY UROLOGY SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:GILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-732-6770
Mailing Address - Street 1:PO BOX 3421
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02361-3421
Mailing Address - Country:US
Mailing Address - Phone:508-732-6770
Mailing Address - Fax:508-732-6780
Practice Address - Street 1:135 SANDWICH ST
Practice Address - Street 2:SUITE B
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2400
Practice Address - Country:US
Practice Address - Phone:508-732-6770
Practice Address - Fax:508-732-6780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80236208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty