Provider Demographics
NPI:1235395179
Name:PLASTIC SURGERY AND DERMATOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PLASTIC SURGERY AND DERMATOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHABNAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHABADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-645-0077
Mailing Address - Street 1:PO BOX 8310
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-0310
Mailing Address - Country:US
Mailing Address - Phone:703-645-0077
Mailing Address - Fax:
Practice Address - Street 1:8501 ARLINGTON BLVD STE 310
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4625
Practice Address - Country:US
Practice Address - Phone:703-645-0077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243725207N00000X
VA0101243338208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty