Provider Demographics
NPI:1477593994
Name:PLASTIC SURGERY OF NORTH CENTRAL OHIO, LLC
Entity Type:Organization
Organization Name:PLASTIC SURGERY OF NORTH CENTRAL OHIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAZOUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-668-7010
Mailing Address - Street 1:278 BENEDICT AVENUE
Mailing Address - Street 2:BUILDING 3, SUITE 450
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2399
Mailing Address - Country:US
Mailing Address - Phone:419-668-7010
Mailing Address - Fax:419-668-7006
Practice Address - Street 1:278 BENEDICT AVENUE
Practice Address - Street 2:BUILDING 3, SUITE 450
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2399
Practice Address - Country:US
Practice Address - Phone:419-668-7010
Practice Address - Fax:419-668-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-056696208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty