Provider Demographics
NPI:1033734595
Name:MAIA PLASTIC SURGERY
Entity Type:Organization
Organization Name:MAIA PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLASTIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:MUNIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-574-4500
Mailing Address - Street 1:8300 GREENSBORO DR STE L1-180
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3605
Mailing Address - Country:US
Mailing Address - Phone:703-574-4500
Mailing Address - Fax:443-949-7508
Practice Address - Street 1:8100 BOONE BOULEVARD
Practice Address - Street 2:SUITE 730
Practice Address - City:TYSONS CORNER
Practice Address - State:VA
Practice Address - Zip Code:22182-2688
Practice Address - Country:US
Practice Address - Phone:703-574-4500
Practice Address - Fax:443-949-7508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty