Provider Demographics
NPI:1417600198
Name:DR. GIANCARLO PLASTIC SURGERY, PLLC
Entity Type:Organization
Organization Name:DR. GIANCARLO PLASTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GIANCARLO
Authorized Official - Middle Name:
Authorized Official - Last Name:MCEVENUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-524-9672
Mailing Address - Street 1:851 MEADOWS RD STE 222
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2348
Mailing Address - Country:US
Mailing Address - Phone:561-524-9672
Mailing Address - Fax:
Practice Address - Street 1:851 MEADOWS RD STE 222
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2348
Practice Address - Country:US
Practice Address - Phone:561-524-9672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty