Healthcare Provider Details

I. General information

NPI: 1295798122
Provider Name (Legal Business Name): PARK SURGICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PEARL STREET STE 2700
BROCKTON MA
02301-2870
US

IV. Provider business mailing address

1 PEARL STREET STE 2700
BROCKTON MA
02301-2870
US

V. Phone/Fax

Practice location:
  • Phone: 508-584-4104
  • Fax: 508-584-4105
Mailing address:
  • Phone: 508-584-4104
  • Fax: 508-584-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER J COREY
Title or Position: PRESIDENT PHYSICIAN
Credential: MD
Phone: 508-584-4104