Provider Demographics
NPI:1184019176
Name:CIRILLO CENTER FOR PLASTIC SURGERY
Entity Type:Organization
Organization Name:CIRILLO CENTER FOR PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CIRILLO HYLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-525-0500
Mailing Address - Street 1:919 CONESTOGA RD
Mailing Address - Street 2:BLDG 2, SUITE 105
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1352
Mailing Address - Country:US
Mailing Address - Phone:610-525-0500
Mailing Address - Fax:610-525-2575
Practice Address - Street 1:919 CONESTOGA RD
Practice Address - Street 2:BLDG 2, SUITE 105
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1352
Practice Address - Country:US
Practice Address - Phone:610-525-0500
Practice Address - Fax:610-525-2575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD046466L208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
026940Medicare PIN