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General NPI Number Information
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NPI Number | 1154506103
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Entity Type | Organization
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Legal Business Name | PLASTIC COSMETIC & RECONSTRUCTIVE SURGERY OF MERRIMACK VALLEY INC
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 10/22/2012
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Provider Practice Location Address
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Address Line | 451 ANDOVER ST
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City | NORTH ANDOVER
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State | MA
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Zip | 01845-5044
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Country | US
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Telephone | 978-687-1313
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Fax | 978-685-8910
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Provider Business Mailing Address
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Address Line | 451 ANDOVER ST
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City | NORTH ANDOVER
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State | MA
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Zip | 01845-5044
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Country | US
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Telephone | 978-687-1313
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Fax | 978-685-8910
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN JOSEPH SCULLY
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Credential | M.D.
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Telephone | 978-687-1313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 27779
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License Number State | MA
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