Provider Demographics
NPI:1578737599
Name:RENAISSANCE PLASTIC SURGEONS LTD
Entity Type:Organization
Organization Name:RENAISSANCE PLASTIC SURGEONS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:PAPAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-334-7800
Mailing Address - Street 1:185 WADSWORTH RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8330
Mailing Address - Country:US
Mailing Address - Phone:330-334-7800
Mailing Address - Fax:330-334-3252
Practice Address - Street 1:185 WADSWORTH RD
Practice Address - Street 2:SUITE J
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8330
Practice Address - Country:US
Practice Address - Phone:330-334-7800
Practice Address - Fax:330-334-3252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2900034Medicaid
OH2900034Medicaid