Provider Demographics
NPI:1386812840
Name:BOSTON FACIAL PLASTIC SURGERY, P.C.
Entity type:Organization
Organization Name:BOSTON FACIAL PLASTIC SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFFI
Authorized Official - Middle Name:
Authorized Official - Last Name:DER SARKISSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-472-3137
Mailing Address - Street 1:1686 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3383
Mailing Address - Country:US
Mailing Address - Phone:617-927-0037
Mailing Address - Fax:
Practice Address - Street 1:500 CONGRESS ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0908
Practice Address - Country:US
Practice Address - Phone:617-472-3137
Practice Address - Fax:617-472-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150911174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3152391Medicaid
MAM18940OtherBLUE CROSS BLUE SHIELD