Provider Demographics
NPI:1316000995
Name:LONGWOOD PLASTIC SURGERY, P.C.
Entity Type:Organization
Organization Name:LONGWOOD PLASTIC SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-383-6250
Mailing Address - Street 1:235 CYPRESS ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6776
Mailing Address - Country:US
Mailing Address - Phone:617-383-6250
Mailing Address - Fax:617-383-6255
Practice Address - Street 1:235 CYPRESS ST
Practice Address - Street 2:SUITE 210
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-6776
Practice Address - Country:US
Practice Address - Phone:617-383-6250
Practice Address - Fax:617-383-6255
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LONGWOOD PLASTIC SURGERY, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-18
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208200000X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA688749OtherTUFTS ASSOCIATED HEALTH PLANS
MAM18020OtherBCBS GROUP NUMBER
MA0026491OtherNEIGHBORHOOD HEALTH PLAN
MA9714430Medicaid
MA9714430Medicaid
MAM21040Medicare PIN