Provider Demographics
NPI:1205867702
Name:WAUGH CHAPEL PLASTIC SURGERY SPECIALISTS
Entity Type:Organization
Organization Name:WAUGH CHAPEL PLASTIC SURGERY SPECIALISTS
Other - Org Name:PLASTIC SURGERY SPECIALISTS, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-841-5355
Mailing Address - Street 1:2401 BRANDERMILL BLVD.
Mailing Address - Street 2:SUITE 160
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054
Mailing Address - Country:US
Mailing Address - Phone:410-841-5355
Mailing Address - Fax:410-841-6821
Practice Address - Street 1:2448 HOLLY AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3148
Practice Address - Country:US
Practice Address - Phone:410-841-5355
Practice Address - Fax:410-841-6821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21C001434OtherMEDICARE SUPPLIER ID NUMB