Organization
MEDICAL CENTER ORTHOTICS AND PROSTHETICS, LLC
Active
Other names
South Shore Orthopedic Labs Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE CORCORAN CPO (CEO)
(301) 585-5347
Entity
Organization
Contact information
Practice address
199 REEDSDALE RD, MILTON, MA 02186
(617) 698-6334
(617) 698-3260
Mailing address
2421 LINDEN LN, SILVER SPRING, MD 20910-1230
(301) 585-5347
(301) 585-4383
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
—
—
225000000X
Orthotic Fitter
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102441600
US DEPT OF LABOR PROV ID
MA
05
—
1501003
—
MA
01
—
240254
BLUE CROSS BLUE SHIELD ID
MA
01
—
3137161
CIGNA PROVIDER ID
MA
01
—
800550
HARVARD PILGRIM PROV ID
MA
01
—
801088
TUFTS HEALTH PLAN PROV ID
MA
Enumeration date
07/07/2006
Last updated
09/11/2023
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