MEDICARE: BOSTON PLASTIC SURGERY ASSOCIATES, PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
2	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician
3	2086S0122X	Plastic and Reconstructive Surgery Physician
4	208200000X	Plastic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417955402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOSTON PLASTIC SURGERY ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	340 MAIN ST
Second Line	:	STE. 670
City	:	WORCESTER
State	:	MA
Zip	:	01608-1604
Country	:	US
Telephone Number	:	508-754-3566
Fax Number	:	508-438-6364

Provider Business Practice Location Address
First Line	:	1153 CENTRE ST
Second Line	:	SUITE 5790
City	:	BOSTON
State	:	MA
Zip	:	02130-3446
Country	:	US
Telephone Number	:	617-522-0008
Fax Number	:	617-522-2587

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELEANOR C PITTS
Credential	:	MD
Telephone Number	:	617-522-0008

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	10/04/2011

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