Provider Demographics
NPI:1164521241
Name:PLASTIC SURGERY SPECIALISTS PC
Entity Type:Organization
Organization Name:PLASTIC SURGERY SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:M.
Authorized Official - Middle Name:T
Authorized Official - Last Name:MONTEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:610-935-5600
Mailing Address - Street 1:PO BOX 604
Mailing Address - Street 2:1288 VALLEY FORGE RD SUITE 64
Mailing Address - City:VALLEY FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:19482
Mailing Address - Country:US
Mailing Address - Phone:610-935-5600
Mailing Address - Fax:610-935-0830
Practice Address - Street 1:1288 VALLEY FORGE RD SUITE 65
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460
Practice Address - Country:US
Practice Address - Phone:610-935-5600
Practice Address - Fax:610-935-0830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA535208Medicare ID - Type Unspecified