Provider Demographics
NPI:1083000145
Name:THE CENTER FOR LASER AND AESTHETIC MEDICINE LLC
Entity Type:Organization
Organization Name:THE CENTER FOR LASER AND AESTHETIC MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SABOUNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-819-1878
Mailing Address - Street 1:PO BOX 1360
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18044-1360
Mailing Address - Country:US
Mailing Address - Phone:610-438-2990
Mailing Address - Fax:610-438-2986
Practice Address - Street 1:3735 NAZARETH RD STE 201
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-8346
Practice Address - Country:US
Practice Address - Phone:610-438-2990
Practice Address - Fax:610-438-2986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207N00000X, 207RA0401X, 207V00000X, 2084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic MedicineGroup - Multi-Specialty