Provider Demographics
NPI:1336100320
Name:AKRON PLASTIC SURGEONS, INC.
Entity Type:Organization
Organization Name:AKRON PLASTIC SURGEONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-253-9161
Mailing Address - Street 1:1 PARK WEST BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-4218
Mailing Address - Country:US
Mailing Address - Phone:330-253-9161
Mailing Address - Fax:330-253-5933
Practice Address - Street 1:1 PARK WEST BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-4218
Practice Address - Country:US
Practice Address - Phone:330-253-9161
Practice Address - Fax:330-253-5933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9265591Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER