Healthcare Provider Details

I. General information

NPI: 1326898503
Provider Name (Legal Business Name): ORTHOPEDIC AND SPINE SPECIALISTS OF MA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 BEACON ST STE 800
BOSTON MA
02108-3021
US

IV. Provider business mailing address

11 BEACON ST STE 800
BOSTON MA
02108-3021
US

V. Phone/Fax

Practice location:
  • Phone: 561-507-0800
  • Fax: 561-600-8705
Mailing address:
  • Phone: 561-507-0800
  • Fax: 561-600-8705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number State

VIII. Authorized Official

Name: CARIANNE YANTZ
Title or Position: ASSISTANT ADMIN
Credential:
Phone: 561-507-0800