Healthcare Provider Details

I. General information

NPI: 1407294523
Provider Name (Legal Business Name): PLEXUS ANESTHESIA SERVICES OF MASSACHUSETTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 CANTON ST SUITE # 325
WESTWOOD MA
02090-2321
US

IV. Provider business mailing address

690 CANTON ST SUITE # 325
WESTWOOD MA
02090-2321
US

V. Phone/Fax

Practice location:
  • Phone: 781-407-7713
  • Fax: 781-407-0998
Mailing address:
  • Phone: 781-407-7713
  • Fax: 781-407-0998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL REALE
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 781-915-0218