Organization
PLASTIC SURG ASSOC OF THE SOUTH SHORE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC A FREDERICKSON M.D. (OWNER)
(781) 749-9071
Entity
Organization
Contact information
Practice address
680 CENTRE ST, BROCKTON, MA 02302-3308
(781) 749-9071
(781) 749-2133
Mailing address
PO BOX 86, HINGHAM, MA 02043-0086
(781) 749-9071
(781) 749-2133
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
29097
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
600169
TUFTS
MA
01
—
M11183
BCBS MA
MA
Enumeration date
03/19/2008
Last updated
07/29/2008
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