Provider Demographics
NPI:1639490519
Name:COSMETIC PLASTIC SURGERY AND LASER CENTER LLC
Entity Type:Organization
Organization Name:COSMETIC PLASTIC SURGERY AND LASER CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMERCURIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-714-4466
Mailing Address - Street 1:49 ST PAUL DR
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-1020
Mailing Address - Country:US
Mailing Address - Phone:717-261-1620
Mailing Address - Fax:717-261-5912
Practice Address - Street 1:49 ST. PAUL DRIVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201
Practice Address - Country:US
Practice Address - Phone:717-261-1620
Practice Address - Fax:717-261-5912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization