Provider Demographics
NPI:1891986105
Name:CENTER FOR COMPUTER ASSISTED AND RECONSTRUCTIVE SURGERY INC
Entity Type:Organization
Organization Name:CENTER FOR COMPUTER ASSISTED AND RECONSTRUCTIVE SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SIMPSON-MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-232-3040
Mailing Address - Street 1:61 WEDGEMERE AVENUE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890
Mailing Address - Country:US
Mailing Address - Phone:617-232-3040
Mailing Address - Fax:617-754-6436
Practice Address - Street 1:125 PARKER HILL AVENUE
Practice Address - Street 2:SUITE 545
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120
Practice Address - Country:US
Practice Address - Phone:617-232-3040
Practice Address - Fax:617-754-6436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58245174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA694495OtherTUFTS
MACEM18202OtherBCBS
MAM21283Medicare PIN
MAE16382Medicare UPIN