Healthcare Provider Details

I. General information

NPI: 1679885164
Provider Name (Legal Business Name): HARRINGTON PLASTIC SURGERY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 FRANCE AVE S 510
EDINA MN
55435-4534
US

IV. Provider business mailing address

7373 FRANCE AVE S 510
EDINA MN
55435-4534
US

V. Phone/Fax

Practice location:
  • Phone: 651-290-7600
  • Fax:
Mailing address:
  • Phone: 651-290-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number37988
License Number StateMN

VIII. Authorized Official

Name: MRS. KATHY KAYE MATSON
Title or Position: MANAGER
Credential:
Phone: 651-290-7600