NPIMap

Organization Active NPI

Taylor and Sullivan Plastic Surgery

  • Plastic Surgery Physician
  • Cambridge, MA
National Provider Identifier
1376072116
Registry record updated Sep 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
Legal business name
TAYLOR AND SULLIVAN PLASTIC SURGERY
Practice address
300 Mount Auburn St Ste 304
Cambridge, MA 02138-5665
Phone
(617) 492-0620
Fax
(617) 492-0631
NPI assigned
Jun 6, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stephen R Sullivan, MDNPI 1154412906
Title
Partner
Phone
(617) 492-0620

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X Primary

Addresses

Primary practice location

300 Mount Auburn St Ste 304
Cambridge, MA 02138-5665

Mailing address

300 Mount Auburn St Ste 304
Cambridge, MA 02138-5665
Phone (617) 492-0620

Other identifiers 2

IdentifierTypeStateIssuer
1154412906MedicaidWA
1144309006MedicaidMA

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

300 Mount Auburn St
Ste 304
Cambridge, MA 02138
Phone (617) 492-0620

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1496707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694736000000",
    "number": "1376072116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 MOUNT AUBURN ST STE 304",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021385665",
            "telephone_number": "617-492-0620",
            "fax_number": "617-492-0631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 MOUNT AUBURN ST STE 304",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021385665",
            "telephone_number": "617-492-0620",
            "fax_number": "617-492-0631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAYLOR AND SULLIVAN PLASTIC SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-06",
        "last_updated": "2023-09-15",
        "certification_date": "2023-09-15",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "617-492-0620",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154412906",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1144309006",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cambridge, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.