Provider Demographics
NPI:1164580387
Name:DELLON INSTITUTE FOR PERIPHERAL NERVE SURGERY
Entity Type:Organization
Organization Name:DELLON INSTITUTE FOR PERIPHERAL NERVE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COOWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-721-0500
Mailing Address - Street 1:1269 BEACON ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5245
Mailing Address - Country:US
Mailing Address - Phone:781-721-0500
Mailing Address - Fax:781-721-5719
Practice Address - Street 1:1269 BEACON ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5245
Practice Address - Country:US
Practice Address - Phone:781-721-0500
Practice Address - Fax:781-721-5719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA218005174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21523Medicare ID - Type Unspecified