Healthcare Provider Details

I. General information

NPI: 1134293814
Provider Name (Legal Business Name): PLYMOUTH LASER CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 INDUSTRIAL PARK RD
PLYMOUTH MA
02360-7243
US

IV. Provider business mailing address

PO BOX 4176 PLC DEPT 200
WOBURN MA
01888-4176
US

V. Phone/Fax

Practice location:
  • Phone: 508-833-6000
  • Fax: 508-534-6060
Mailing address:
  • Phone: 508-833-6000
  • Fax: 508-534-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN HERLIHY
Title or Position: ADMINISTRATOR
Credential:
Phone: 508-833-2010