Healthcare Provider Details

I. General information

NPI: 1326094277
Provider Name (Legal Business Name): PLASTIC SURGERY OF WINCHESTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 DIX STREET
WINCHESTER MA
01890-1870
US

IV. Provider business mailing address

15 DIX STREET
WINCHESTER MA
01890-1870
US

V. Phone/Fax

Practice location:
  • Phone: 781-729-0947
  • Fax: 781-729-3569
Mailing address:
  • Phone: 781-729-0947
  • Fax: 781-729-3569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number32985
License Number StateMA

VIII. Authorized Official

Name: DR. FRANK R VIRNELLI
Title or Position: SOLE PROPRIETOR
Credential: MD
Phone: 781-729-0947