PLASTIC & HAND SURGICAL ASSOCIATES - NPI 1104214204

Q: What is Plastic & Hand Surgical Associates's NPI number?

The NPI number for Plastic & Hand Surgical Associates is 1104214204. It was assigned to this organization in the NPPES registry on December 26, 2014.

Q: What is Plastic & Hand Surgical Associates's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

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About Plastic & Hand Surgical Associates NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PLASTIC & HAND SURGICAL ASSOCIATES (NPI 1104214204) is a healthcare organization registered as a specialist in Westbrook, Maine and active in the NPI registry since December 2014. The organization holds a CLIA Waiver certificate valid through June 20, 2028, maintains a secondary practice location in South Portland, and lists Colette Bergeron Davies, Practice Administrator, as its authorized official.

NPPES Registry Identity

NPI1104214204

Entity TypeOrganization

Primary Taxonomy174400000X

Legal Business NamePLASTIC & HAND SURGICAL ASSOCIATES

Location Address11 ROCK ROW STE 210Westbrook, ME 04092-4877

Mailing Address11 Rock Row Ste 210Westbrook, ME 04092-4877 · (207) 775-3446 · Fax (207) 879-4188

Phone(207) 775-3446

Fax(207) 879-1646

Organization SubpartNo

Authorized OfficialColette Bergeron DaviesPractice Administrator · (207) 775-3446

Enumeration DateDecember 26, 2014

Last NPPES UpdateJanuary 26, 20265 updates tracked since enumeration

NPPES CertifiedJanuary 26, 2026

✔ NPI 1104214204 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers

Taxonomy Code174400000X

Definition

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

11 ROCK ROW STE 210, Westbrook, ME 04092

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Secondary Practice Location 1

Location 1244 Western AveSouth Portland, ME 04106-2430 · Phone (207) 775-3446 · Fax (207) 879-4188

Other Identifiers 1

Medicaid107150000ME

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 20D2042872

Plastic & Hand Surgical Associates Dba Surgery Center At Plastic & Hand · South Portland, ME

Active · expires Jun 20, 2028

CLIA Number20D2042872

Laboratory TypeAmbulatory Surgery Center

Certificate Effective DateJune 21, 2026

Certificate Expiration DateJune 20, 2028

Laboratory DirectorSirish Marddali

Laboratory Phone(207) 775-3446

Laboratory LocationPlastic & Hand Surgical Associates Dba Surgery Center At Plastic & Hand11 Rock Row Suite 210, South Portland, ME 04106

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KELLI R HICKLE M.D.

Surgery (Plastic and Reconstructive Surgery)