Provider Demographics
NPI:1821254905
Name:LOUDOUN CENTER FOR PLASTIC SURGERY LLC
Entity Type:Organization
Organization Name:LOUDOUN CENTER FOR PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-726-1175
Mailing Address - Street 1:45155 RESEARCH PL
Mailing Address - Street 2:SUITE 125
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4191
Mailing Address - Country:US
Mailing Address - Phone:703-726-1175
Mailing Address - Fax:703-726-9975
Practice Address - Street 1:45155 RESEARCH PL
Practice Address - Street 2:SUITE 125
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4191
Practice Address - Country:US
Practice Address - Phone:703-726-1175
Practice Address - Fax:703-726-9975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101225608208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty