Healthcare Provider Details

I. General information

NPI: 1467791665
Provider Name (Legal Business Name): NESC MACIPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MILL ST STE 304
ARLINGTON MA
02476-4778
US

IV. Provider business mailing address

526 MAIN ST STE 302
ACTON MA
01720-3301
US

V. Phone/Fax

Practice location:
  • Phone: 781-641-4900
  • Fax: 781-641-4904
Mailing address:
  • Phone: 978-371-7010
  • Fax: 978-371-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number160016
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number205725
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number153438
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number79526
License Number StateMA

VIII. Authorized Official

Name: SAMUEL D GOOS
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 978-371-7010