Provider Demographics
NPI:1073581542
Name:PLASTIC AND RECONSTRUCTIVE SURGERY, P.C.
Entity Type:Organization
Organization Name:PLASTIC AND RECONSTRUCTIVE SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER SEC TREA OF CORP
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:ELDRIDGE
Authorized Official - Last Name:BORN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:717-741-9599
Mailing Address - Street 1:2295 S GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403
Mailing Address - Country:US
Mailing Address - Phone:717-741-9599
Mailing Address - Fax:717-741-0420
Practice Address - Street 1:2295 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403
Practice Address - Country:US
Practice Address - Phone:717-741-9599
Practice Address - Fax:717-741-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001164812004Medicaid
PA742753OtherBLUE SHIELD
PA20009842OtherAMERIHEALTH MERCY
PA240006830OtherRAILROAD MEDICARE
PA742753OtherKEYSTONE
PA1523691OtherGATEWAY
P018712A002OtherCHAMPUS
01873201OtherCAPITAL BLUE CROSS
C34693Medicare UPIN
PA001164812004Medicaid