Provider Demographics
NPI:1033259460
Name:NORTH SUBURBAN SURGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:NORTH SUBURBAN SURGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:DARIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:AMERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-662-2288
Mailing Address - Street 1:3 WOODLAND ROAD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180
Mailing Address - Country:US
Mailing Address - Phone:781-662-2288
Mailing Address - Fax:781-662-7546
Practice Address - Street 1:3 WOODLAND ROAD
Practice Address - Street 2:SUITE 212
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180
Practice Address - Country:US
Practice Address - Phone:781-662-2288
Practice Address - Fax:781-662-7546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2019-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57581208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA706874OtherTUFTS
MA3023761Medicaid
MAJ06213OtherBLUE SHIELD
J06213Medicare ID - Type Unspecified
MA3023761Medicaid