Provider Demographics
NPI:1982770046
Name:RIVERSONG PLASTIC SURGERY, PC
Entity Type:Organization
Organization Name:RIVERSONG PLASTIC SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-462-8300
Mailing Address - Street 1:21 HIGHLAND AVE
Mailing Address - Street 2:SUITE 3-4A
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3872
Mailing Address - Country:US
Mailing Address - Phone:978-462-8300
Mailing Address - Fax:978-462-8301
Practice Address - Street 1:21 HIGHLAND AVE
Practice Address - Street 2:SUITE 3-4A
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3872
Practice Address - Country:US
Practice Address - Phone:978-462-8300
Practice Address - Fax:978-462-8301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAH93155Medicare UPIN
MAE54880Medicare UPIN