Provider Demographics
NPI:1568157568
Name:DR MARK PLASTIC SURGERY PLLC
Entity Type:Organization
Organization Name:DR MARK PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEAGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLMSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-848-2757
Mailing Address - Street 1:5410 N SCOTTSDALE RD STE A200
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-5958
Mailing Address - Country:US
Mailing Address - Phone:480-848-2757
Mailing Address - Fax:480-634-7935
Practice Address - Street 1:5410 N SCOTTSDALE RD STE A200
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-5958
Practice Address - Country:US
Practice Address - Phone:480-848-2757
Practice Address - Fax:480-634-7935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty