Provider Demographics
NPI:1487790895
Name:CAPE COD PLASTIC SURGERY INC
Entity type:Organization
Organization Name:CAPE COD PLASTIC SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:FATER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-771-0290
Mailing Address - Street 1:51 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3109
Mailing Address - Country:US
Mailing Address - Phone:508-771-0290
Mailing Address - Fax:508-771-8671
Practice Address - Street 1:51 MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3109
Practice Address - Country:US
Practice Address - Phone:508-771-0290
Practice Address - Fax:508-771-8671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81511208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21044Medicare PIN
MAG10514Medicare UPIN