Provider Demographics
NPI:1295878171
Name:CAPE COD PLASTIC & HAND SURGEONS, INC.
Entity type:Organization
Organization Name:CAPE COD PLASTIC & HAND SURGEONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BENTIVEGNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-771-4263
Mailing Address - Street 1:PO BOX 693
Mailing Address - Street 2:
Mailing Address - City:SOUTH YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02664-0693
Mailing Address - Country:US
Mailing Address - Phone:508-771-4263
Mailing Address - Fax:508-771-7906
Practice Address - Street 1:150 ANSEL HALLET RD
Practice Address - Street 2:SUITE A
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-2582
Practice Address - Country:US
Practice Address - Phone:508-771-4263
Practice Address - Fax:508-771-7906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76228208200000X, 2082S0105X, 2086S0122X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA614206OtherTUFTS HEALTH PLANS PAYEE
MAM20039Medicare ID - Type UnspecifiedGROUP NUMBER