Provider Demographics
NPI:1083802847
Name:THE CENTER FOR PLASTIC SURGERY AT RIDGEWOOD HILL LLC
Entity Type:Organization
Organization Name:THE CENTER FOR PLASTIC SURGERY AT RIDGEWOOD HILL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-444-4343
Mailing Address - Street 1:PO BOX 4127
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153
Mailing Address - Country:US
Mailing Address - Phone:540-981-9394
Mailing Address - Fax:540-344-7154
Practice Address - Street 1:2880 KEAGY RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7458
Practice Address - Country:US
Practice Address - Phone:540-444-4343
Practice Address - Fax:540-444-4345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A13057Medicare UPIN