Provider Demographics
NPI:1790838845
Name:COSMETIC SURGERY SPECIALISTS OF MEMPHIS, PLLC
Entity Type:Organization
Organization Name:COSMETIC SURGERY SPECIALISTS OF MEMPHIS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALDEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-752-1412
Mailing Address - Street 1:6401 POPLAR AVE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4823
Mailing Address - Country:US
Mailing Address - Phone:901-752-1412
Mailing Address - Fax:
Practice Address - Street 1:6401 POPLAR AVE
Practice Address - Street 2:SUITE 360
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4823
Practice Address - Country:US
Practice Address - Phone:901-752-1412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB87684Medicare UPIN
TNF93449Medicare UPIN
TN3087482Medicare ID - Type UnspecifiedPETER A. ALDEA, MD
TN3087491Medicare ID - Type UnspecifiedPATRICIA L EBY, MD
TN3712849Medicare ID - Type UnspecifiedCOSMETIC SURGERY SPECIALI