Provider Demographics
NPI:1518041979
Name:THE CENTER OF AESTHETIC AND RECONSTRUCTIVE SURGERY OF YORK, PC
Entity Type:Organization
Organization Name:THE CENTER OF AESTHETIC AND RECONSTRUCTIVE SURGERY OF YORK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DABB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-741-4746
Mailing Address - Street 1:25 MONUMENT RD
Mailing Address - Street 2:SUITE 292
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-5060
Mailing Address - Country:US
Mailing Address - Phone:717-741-4746
Mailing Address - Fax:
Practice Address - Street 1:25 MONUMENT RD
Practice Address - Street 2:SUITE 292
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5060
Practice Address - Country:US
Practice Address - Phone:717-741-4746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD012463E208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA770489OtherHIGHMARK BS
PA02899000OtherCAPITAL BC
PA02899000OtherCAPITAL BC
PA770489OtherHIGHMARK BS