Provider Demographics
NPI:1619107323
Name:NORTHEAST INSTITUTE OF PLASTIC SURGERY INC
Entity Type:Organization
Organization Name:NORTHEAST INSTITUTE OF PLASTIC SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:MICHAUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-828-4840
Mailing Address - Street 1:875 CENTERVILLE ROAD
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886
Mailing Address - Country:US
Mailing Address - Phone:401-828-4840
Mailing Address - Fax:401-828-9570
Practice Address - Street 1:875 CENTERVILLE ROAD
Practice Address - Street 2:BUILDING 2
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-828-4840
Practice Address - Fax:401-828-9570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10018208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIF77555Medicare UPIN