Provider Demographics
NPI:1124036843
Name:COSMETIC SURGERY CENTER FOR WOMEN
Entity Type:Organization
Organization Name:COSMETIC SURGERY CENTER FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-497-5400
Mailing Address - Street 1:396 SOUTH WITCHDUCK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462
Mailing Address - Country:US
Mailing Address - Phone:757-497-5400
Mailing Address - Fax:757-497-8811
Practice Address - Street 1:396 SOUTH WITCHDUCK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462
Practice Address - Country:US
Practice Address - Phone:757-497-5400
Practice Address - Fax:757-497-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051490208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0101051490OtherLICENSE #
218188OtherBLUE SHIELD
1300214OtherUHUH
218188OtherBCFED
VA218188OtherANTHEM BCBS
218188OtherBCBC
38420OtherSHSOPTIMA
5158493OtherAETNA
218188OtherBCHKP
VA218188OtherANTHEM BCBS
G55036Medicare UPIN