Provider Demographics
NPI:1447422894
Name:R. A. PLASTIC SURGERY, L.L.C
Entity Type:Organization
Organization Name:R. A. PLASTIC SURGERY, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:K
Authorized Official - Last Name:ALOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-296-6699
Mailing Address - Street 1:10845 PHILADELPHIA RD
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-1717
Mailing Address - Country:US
Mailing Address - Phone:410-335-0008
Mailing Address - Fax:410-335-3113
Practice Address - Street 1:530 E JOPPA RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5470
Practice Address - Country:US
Practice Address - Phone:410-296-6699
Practice Address - Fax:410-296-6689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056338208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCJ745OtherCAREFIRST
MD913MOtherMEDICARE
GADC3492OtherRAILROAD MEDICARE
MD407038100OtherMEDICAL ASSISTANCE
MD876RAOtherCAREFIRST