Provider Demographics
NPI:1518153071
Name:PATRICK V MARASCO JR, MD, PC
Entity Type:Organization
Organization Name:PATRICK V MARASCO JR, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLASTIC SURGEON/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:V
Authorized Official - Last Name:MARASCO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:978-687-3242
Mailing Address - Street 1:43 HIGH ST
Mailing Address - Street 2:SUITE 110B
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-2646
Mailing Address - Country:US
Mailing Address - Phone:978-687-3242
Mailing Address - Fax:978-208-8414
Practice Address - Street 1:43 HIGH ST
Practice Address - Street 2:SUITE 110B
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-2646
Practice Address - Country:US
Practice Address - Phone:978-687-3242
Practice Address - Fax:978-208-8414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA561062086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM20120OtherMEDICARE
MA3006620Medicaid
MA706025OtherTUFTS
MAJ05874OtherBLUE SHIELD
MA706025OtherTUFTS