Provider Demographics
NPI:1376533067
Name:PLASTIC SURGERY SPECIALISTS, PC
Entity Type:Organization
Organization Name:PLASTIC SURGERY SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:EMORY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-623-4500
Mailing Address - Street 1:112 ABINGDON PL
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-5197
Mailing Address - Country:US
Mailing Address - Phone:276-623-4500
Mailing Address - Fax:276-623-4510
Practice Address - Street 1:112 ABINGDON PL
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-5197
Practice Address - Country:US
Practice Address - Phone:276-623-4500
Practice Address - Fax:276-623-4510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01018404542086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
427211OtherCOMBINED INSURANCE
VA6900283Medicaid
VA451661OtherANTHEM
VA451661OtherANTHEM
=========OtherTRICARE
VA6900283Medicaid