Provider Demographics
NPI:1326094277
Name:PLASTIC SURGERY OF WINCHESTER PC
Entity Type:Organization
Organization Name:PLASTIC SURGERY OF WINCHESTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:R
Authorized Official - Last Name:VIRNELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-729-0947
Mailing Address - Street 1:15 DIX STREET
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-1870
Mailing Address - Country:US
Mailing Address - Phone:781-729-0947
Mailing Address - Fax:781-729-3569
Practice Address - Street 1:15 DIX STREET
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1870
Practice Address - Country:US
Practice Address - Phone:781-729-0947
Practice Address - Fax:781-729-3569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA32985208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA600556OtherTUFTS
MA21731OtherHARVARD PILGRIM
MAM12350OtherBCBS
MA9712526Medicaid
M12350Medicare ID - Type Unspecified
MA9712526Medicaid