Provider Demographics
NPI:1801032586
Name:ADVANCED PLASTIC SURGERY, P.A.
Entity Type:Organization
Organization Name:ADVANCED PLASTIC SURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NASSIF
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:SOUEID
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:410-321-0808
Mailing Address - Street 1:10845 PHILADELPHIA RD
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-1717
Mailing Address - Country:US
Mailing Address - Phone:410-335-0008
Mailing Address - Fax:410-335-3113
Practice Address - Street 1:7505 OSLER DR
Practice Address - Street 2:SUITE 403
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7736
Practice Address - Country:US
Practice Address - Phone:410-321-0808
Practice Address - Fax:410-321-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-30
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD140156OtherMEDICARE
MD419880800OtherMEDICAL ASSISTANCE
DCM775OtherCAREFIRST
MDFDG1NAOtherCAREFIRST
GADQ6413OtherRAILROAD MEDICARE