Provider Demographics
NPI:1508085028
Name:BOSTON SURGICAL GROUP, INC.
Entity Type:Organization
Organization Name:BOSTON SURGICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:
Authorized Official - Last Name:LACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-480-8883
Mailing Address - Street 1:16 GASLIGHT LN
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-5540
Mailing Address - Country:US
Mailing Address - Phone:508-480-8883
Mailing Address - Fax:
Practice Address - Street 1:77 TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772-2110
Practice Address - Country:US
Practice Address - Phone:508-481-0300
Practice Address - Fax:617-752-3690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA531602086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB97925Medicare UPIN