Provider Demographics
NPI:1427170661
Name:MORTON SURGICAL, P.C.
Entity type:Organization
Organization Name:MORTON SURGICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:THAYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-824-4535
Mailing Address - Street 1:72 WASHINGTON ST
Mailing Address - Street 2:SUITE 2700
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2491
Mailing Address - Country:US
Mailing Address - Phone:508-824-4535
Mailing Address - Fax:508-880-7515
Practice Address - Street 1:72 WASHINGTON ST
Practice Address - Street 2:SUITE 2700
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2491
Practice Address - Country:US
Practice Address - Phone:508-824-4535
Practice Address - Fax:508-880-7515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9764062Medicaid
MAM15245OtherBLUE SHIELD
MA607281OtherTUFTS
MA80278OtherAETNA
MAM15245OtherBLUE SHIELD