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General NPI Number Information
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NPI Number | 1508085028
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Entity Type | Organization
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Legal Business Name | BOSTON SURGICAL GROUP, INC.
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 08/07/2020
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Provider Practice Location Address
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Address Line | 77 TURNPIKE RD
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City | SOUTHBOROUGH
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State | MA
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Zip | 01772-2110
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Country | US
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Telephone | 508-481-0300
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Fax | 617-752-3690
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Provider Business Mailing Address
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Address Line | 16 GASLIGHT LN
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City | FRAMINGHAM
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State | MA
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Zip | 01702-5540
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Country | US
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Telephone | 508-480-8883
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELLIOT LACH
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Credential | MD
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Telephone | 508-480-8883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 53160
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License Number State | MA
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