Basic Information
| Provider Information | |||||||||
| NPI: | 1033881198 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EXCEL ORTHOPAEDIC SPECIALISTS MACIPA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 UNICORN PARK DR STE 201 | ||||||||
| Address2: | |||||||||
| City: | WOBURN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018013342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817821300 | ||||||||
| FaxNumber: | 7817821350 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 MOUNT AUBURN ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021385502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817821300 | ||||||||
| FaxNumber: | 7817821350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2021 | ||||||||
| LastUpdateDate: | 09/28/2021 | ||||||||
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| AuthorizedOfficialLastName: | ALESSANDRO | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7817821320 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | EXCEL ORTHOPEDIC SPECIALISTS INC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.