Provider Demographics
NPI:1154450286
Name:PLASTIC SURGICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PLASTIC SURGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHIAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:DONELAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-244-0990
Mailing Address - Street 1:2000 WASHINGTON ST STE 444
Mailing Address - Street 2:
Mailing Address - City:NEWTON LOWER FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1608
Mailing Address - Country:US
Mailing Address - Phone:617-244-0990
Mailing Address - Fax:617-969-4044
Practice Address - Street 1:2000 WASHINGTON ST STE 444
Practice Address - Street 2:
Practice Address - City:NEWTON LOWER FALLS
Practice Address - State:MA
Practice Address - Zip Code:02462-1608
Practice Address - Country:US
Practice Address - Phone:617-244-0990
Practice Address - Fax:617-969-4044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36527174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY10198Medicare ID - Type Unspecified