MEDICARE: LONGWOOD PLASTIC SURGERY, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center
2	208200000X	Plastic Surgery Physician		MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	688749	OTHER	MA	TUFTS ASSOCIATED HEALTH PLANS
2	M18020	OTHER	MA	BCBS GROUP NUMBER
3	0026491	OTHER	MA	NEIGHBORHOOD HEALTH PLAN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316000995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONGWOOD PLASTIC SURGERY, P.C.

Provider Business Mailing Address
First Line	:	235 CYPRESS ST
Second Line	:	SUITE 210
City	:	BROOKLINE
State	:	MA
Zip	:	02445-6776
Country	:	US
Telephone Number	:	617-383-6250
Fax Number	:	617-383-6255

Provider Business Practice Location Address
First Line	:	235 CYPRESS ST
Second Line	:	SUITE 210
City	:	BROOKLINE
State	:	MA
Zip	:	02445-6776
Country	:	US
Telephone Number	:	617-383-6250
Fax Number	:	617-383-6255

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DONALD JAY MORRIS
Credential	:	M.D.
Telephone Number	:	617-383-6250

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	09/11/2008

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Directions to “LONGWOOD PLASTIC SURGERY, P.C. ” Practice Location

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