MEDICARE: TVCG PLY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician

General Provider Information

NPI Number	:	1710615877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TVCG PLY PLLC

Provider Business Mailing Address
First Line	:	100 CAMP ST
Second Line	:
City	:	HYANNIS
State	:	MA
Zip	:	02601-3063
Country	:	US
Telephone Number	:	508-775-1984
Fax Number	:	508-790-1890

Provider Business Practice Location Address
First Line	:	40 INDUSTRIAL PARK RD STE 203
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-4888
Country	:	US
Telephone Number	:	508-356-6504
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MEMBER
Name	:	DANIEL GORIN
Credential	:	MD
Telephone Number	:	508-775-1984

Provider Enumeration Date	:	08/08/2022
Last Update Date	:	08/08/2022

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