Provider Demographics
NPI:1154424323
Name:NORTHEAST PLASTIC SURGERY, P.C.
Entity type:Organization
Organization Name:NORTHEAST PLASTIC SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-256-7697
Mailing Address - Street 1:15 VILLAGE SQ
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2712
Mailing Address - Country:US
Mailing Address - Phone:978-256-7697
Mailing Address - Fax:
Practice Address - Street 1:15 VILLAGE SQ
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2712
Practice Address - Country:US
Practice Address - Phone:978-256-7697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204149174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ22174OtherBLUE CROSS BLUE SHIELD
MAM21500OtherMEDICARE GROUP NUMBER
MD22763OtherNEIGHBORHOOD HEALH
MA204149OtherTUFTS HEALTH PLAN
MA3208079Medicaid
MA50982OtherFALLON
MA21612OtherHARVARD PILGRIM HEALTH
MAA31433Medicare ID - Type Unspecified
MAJ22174OtherBLUE CROSS BLUE SHIELD