Provider Demographics
NPI:1386650059
Name:NORTHERN VIRGINIA CENTER FOR FACIAL PLASTIC SURGERY PC
Entity Type:Organization
Organization Name:NORTHERN VIRGINIA CENTER FOR FACIAL PLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-790-5709
Mailing Address - Street 1:8180 GREENSBORO DR
Mailing Address - Street 2:SUITE #1015
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3888
Mailing Address - Country:US
Mailing Address - Phone:703-790-5700
Mailing Address - Fax:703-827-8730
Practice Address - Street 1:8180 GREENSBORO DR
Practice Address - Street 2:SUITE #1015
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3888
Practice Address - Country:US
Practice Address - Phone:703-790-5700
Practice Address - Fax:703-827-8730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053960207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G05923Medicare UPIN
014235P21Medicare ID - Type Unspecified