Provider Demographics
NPI:1093908923
Name:AMBULATORY PLASTIC SURGERY CENTER ASSOCIATES, CHARTERED
Entity Type:Organization
Organization Name:AMBULATORY PLASTIC SURGERY CENTER ASSOCIATES, CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-912-4708
Mailing Address - Street 1:15245 SHADY GROVE RD
Mailing Address - Street 2:SUITE 155
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3222
Mailing Address - Country:US
Mailing Address - Phone:240-912-4708
Mailing Address - Fax:240-912-6992
Practice Address - Street 1:15245 SHADY GROVE RD
Practice Address - Street 2:SUITE 155
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3222
Practice Address - Country:US
Practice Address - Phone:240-912-4708
Practice Address - Fax:240-912-6992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01044OtherMEDICARE GROUP NUMBER