Provider Demographics
NPI:1558692491
Name:NATIONAL CENTER FOR PLASTIC SURGERY LLC
Entity Type:Organization
Organization Name:NATIONAL CENTER FOR PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:VENTURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-287-8277
Mailing Address - Street 1:7601 LEWINSVILLE RD
Mailing Address - Street 2:STE 400
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2814
Mailing Address - Country:US
Mailing Address - Phone:703-287-8277
Mailing Address - Fax:703-287-8278
Practice Address - Street 1:7601 LEWINSVILLE RD
Practice Address - Street 2:STE 400
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-2814
Practice Address - Country:US
Practice Address - Phone:703-287-8277
Practice Address - Fax:703-287-8278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233860174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA131415YLTOtherMEDICARE GROUP MEMBER PTAN
VA129497OtherMEDICARE PTAN