Organization
PLASTIC RECONSTRUCTIVE & COSMETIC SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH A MARSHALL M.D., F,.A.C.S. (PRESIDENT)
(781) 489-6228
Entity
Organization
Contact information
Practice address
204 WORCESTER ST, WELLESLEY, MA 02481-5420
(781) 489-6218
(781) 489-6751
Mailing address
204 WORCESTER ST, WELLESLEY, MA 02481-5420
(781) 489-6218
(781) 489-6751
Taxonomy
Speciality
Code
Description
License number
State
2086S0105X
Surgery of the Hand (Surgery) Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
600215
TUFTS HEALTH PLAN
MA
01
—
M12935
BCBS GROUP NUMBER
MA
Enumeration date
10/10/2006
Last updated
01/22/2013
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