Healthcare Provider Details

I. General information

NPI: 1891986105
Provider Name (Legal Business Name): CENTER FOR COMPUTER ASSISTED AND RECONSTRUCTIVE SURGERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PARKER HILL AVENUE SUITE 545
BOSTON MA
02120
US

IV. Provider business mailing address

61 WEDGEMERE AVENUE
WINCHESTER MA
01890
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-3040
  • Fax: 617-754-6436
Mailing address:
  • Phone: 617-232-3040
  • Fax: 617-754-6436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number58245
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number58245
License Number StateMA

VIII. Authorized Official

Name: MRS. MICHELLE MARY SIMPSON-MURPHY
Title or Position: OFFICE MANAGER
Credential:
Phone: 617-232-3040