Provider Demographics
NPI:1083717003
Name:BLAIR PLASTIC SURGERY
Entity Type:Organization
Organization Name:BLAIR PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:LOUDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-949-7280
Mailing Address - Street 1:3107 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:ATTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602
Mailing Address - Country:US
Mailing Address - Phone:814-949-7280
Mailing Address - Fax:814-949-7283
Practice Address - Street 1:3107 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:ATTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602
Practice Address - Country:US
Practice Address - Phone:814-949-7280
Practice Address - Fax:814-949-7283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty