COMMONWEALTH PLASTIC SURGERY LLC NPI 1568854008

NPI Information

  • NPI: 1568854008
  • Provider Name: COMMONWEALTH PLASTIC SURGERY LLC
  • Classification: Surgery - 2086S0122X
  • Specialization: Plastic and Reconstructive Surgery
  • Entity Type: Organization
  • Address: 500 CONGRESS ST
    SUITE B1
    QUINCY, MA
    ZIP 02169
  • Phone: (617) 472-6764

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NPI Details

COMMONWEALTH PLASTIC SURGERY LLC is a plastic and reconstructive surgery surgery in Quincy, MA. The provider is a surgeon who specializes in plastic and reconstructive surgery. COMMONWEALTH PLASTIC SURGERY LLC NPI is 1568854008. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

500 CONGRESS ST
SUITE B1
QUINCY, MA
ZIP 02169-908
Phone: (617) 472-6764
Fax: (617) 770-9933

The provider's authorized official is Genevieve B Broderick .
The authorized official title is Owner and has the following contact phone number (617) 472-6764.

The enumeration date for this NPI number is 2/20/2015 and was last updated on 6/24/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12086S0122XSurgeryPlastic and Reconstructive Surgery233883MASSACHUSETTSYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1S100210913MEDICARE PINMASSACHUSETTS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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