Provider Demographics
NPI:1558149237
Name:TAYLOR SULLIVAN PLASTIC SURGERY LLC
Entity Type:Organization
Organization Name:TAYLOR SULLIVAN PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CULTRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-820-2784
Mailing Address - Street 1:300 MOUNT AUBURN ST STE 304
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5696
Mailing Address - Country:US
Mailing Address - Phone:161-749-2062
Mailing Address - Fax:
Practice Address - Street 1:300 MOUNT AUBURN ST STE 304
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5696
Practice Address - Country:US
Practice Address - Phone:161-749-2062
Practice Address - Fax:617-492-0631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty