Organization
PLASTIC SURGICENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HYTHO H PANTAZELOS MD (PLASTIC SURGEON)
(978) 369-8777
Entity
Organization
Contact information
Practice address
131 ORNAC, JOHN CUMING BUILDING SUITE 510, CONCORD, MA 01742
(978) 369-8777
(978) 369-5554
Mailing address
131 ORNAC, JOHN CUMING BUILDING SUITE 510, CONCORD, MA 01742
(978) 369-8777
(978) 369-5554
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
29312
MA
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
29312
MA
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
29312
MA
208600000X
Surgery Physician
29312
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2010321
—
MA
01
—
2401005280
RR MEDICARE
MA
01
—
B14059
BLUE CROSS
MA
Enumeration date
01/22/2008
Last updated
01/22/2008
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