Provider Demographics
NPI:1609987759
Name:PLASTIC SURGERY CENTER OF PA
Entity Type:Organization
Organization Name:PLASTIC SURGERY CENTER OF PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUNNER
Authorized Official - Middle Name:EO
Authorized Official - Last Name:BERGQVIST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-480-8220
Mailing Address - Street 1:410 CRANBERRY ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1067
Mailing Address - Country:US
Mailing Address - Phone:814-480-8220
Mailing Address - Fax:814-480-8225
Practice Address - Street 1:410 CRANBERRY ST
Practice Address - Street 2:SUITE 310
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1067
Practice Address - Country:US
Practice Address - Phone:814-480-8220
Practice Address - Fax:814-480-8225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty