Provider Demographics
NPI:1780336180
Name:BOSTON CENTER FOR FACIAL PLASTICS
Entity type:Organization
Organization Name:BOSTON CENTER FOR FACIAL PLASTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALEED
Authorized Official - Middle Name:H
Authorized Official - Last Name:EZZAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:857-350-4205
Mailing Address - Street 1:425 BOYLSTON ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3324
Mailing Address - Country:US
Mailing Address - Phone:857-350-4205
Mailing Address - Fax:857-350-4708
Practice Address - Street 1:425 BOYLSTON ST FL 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3324
Practice Address - Country:US
Practice Address - Phone:857-350-4205
Practice Address - Fax:857-350-4708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty