Provider Demographics
NPI:1134293814
Name:PLYMOUTH LASER CENTER, P.C.
Entity Type:Organization
Organization Name:PLYMOUTH LASER CENTER, P.C.
Other - Org Name:PLYMOUTH LASER & SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERLIHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-833-2010
Mailing Address - Street 1:146 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-7243
Mailing Address - Country:US
Mailing Address - Phone:508-833-6000
Mailing Address - Fax:508-534-6060
Practice Address - Street 1:146 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7243
Practice Address - Country:US
Practice Address - Phone:508-833-6000
Practice Address - Fax:508-534-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110031502AMedicaid
608302OtherTUFTS
903042OtherHARVARD PILGRIM
680020OtherUNITED HEALTHCARE
S027793OtherCHAMPUS/TRICARE
MAM88010OtherBC/BS
MA221019Medicare PIN