NPIMap

Organization Active NPI

Pastic and Reconstructive Surgery of Essex County

  • Plastic Surgery Physician
  • Peabody, MA
National Provider Identifier
1518015171
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
29094 Issued in MA
Legal business name
PASTIC AND RECONSTRUCTIVE SURGERY OF ESSEX COUNTY
Practice address
6 Essex Center Dr
Suite 203
Peabody, MA 01960-2910
Phone
(978) 532-3240
Fax
(978) 532-0526
NPI assigned
Jan 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. William R MooreNPI 1548374416
Title
Principle Physician
Phone
(978) 532-3240

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 29094 MA Primary

Addresses

Primary practice location

6 Essex Center Dr
Suite 203
Peabody, MA 01960-2910

Mailing address

6 Essex Center Dr
Suite 203
Peabody, MA 01960-2910
Phone (978) 532-3240

National Provider Directory

National Provider Directory

Locations

6 Essex Center Dr
Ste 203
Peabody, MA 01960
Phone (978) 532-3240

Practitioners & affiliated clinicians

Practitioners 2

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": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1518015171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 ESSEX CENTER DR",
            "address_2": "SUITE 203",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019602910",
            "telephone_number": "978-532-3240",
            "fax_number": "978-532-0526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 ESSEX CENTER DR",
            "address_2": "SUITE 203",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019602910",
            "telephone_number": "978-532-3240",
            "fax_number": "978-532-0526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASTIC AND RECONSTRUCTIVE SURGERY OF ESSEX COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRINCIPLE PHYSICIAN",
        "authorized_official_telephone_number": "978-532-3240",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "MA",
            "license": "29094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peabody, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.