Provider Demographics
NPI:1760436349
Name:PREMIER PLASTIC SURGERY, P.C.
Entity Type:Organization
Organization Name:PREMIER PLASTIC SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:AULICINO
Authorized Official - Suffix:
Authorized Official - Credentials:MPM
Authorized Official - Phone:724-933-1800
Mailing Address - Street 1:14000 PERRY HIGHWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8442
Mailing Address - Country:US
Mailing Address - Phone:724-933-1800
Mailing Address - Fax:724-933-1810
Practice Address - Street 1:14000 PERRY HIGHWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8442
Practice Address - Country:US
Practice Address - Phone:724-933-1800
Practice Address - Fax:724-933-1810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA056369Medicare ID - Type Unspecified