Provider Demographics
NPI:1346205135
Name:STILLWATER PLASTIC SURGERY, PA
Entity Type:Organization
Organization Name:STILLWATER PLASTIC SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CAPIZZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-655-8988
Mailing Address - Street 1:8712 LINDHOLM DR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-1870
Mailing Address - Country:US
Mailing Address - Phone:704-655-8988
Mailing Address - Fax:704-655-8980
Practice Address - Street 1:8712 LINDHOLM DR
Practice Address - Street 2:SUITE 308
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-1870
Practice Address - Country:US
Practice Address - Phone:704-655-8988
Practice Address - Fax:704-655-8980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700210208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910329Medicaid
NC10329OtherBLUE CROSS AND BLUE SHIELD
NC2335227Medicare PIN