Provider Demographics
NPI:1851336135
Name:ALLENTOWN CENTER FOR PLASTIC SURGERY,INC
Entity Type:Organization
Organization Name:ALLENTOWN CENTER FOR PLASTIC SURGERY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLASTIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:PENUMARTHI
Authorized Official - Last Name:CHOWDARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-434-1269
Mailing Address - Street 1:1230 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6212
Mailing Address - Country:US
Mailing Address - Phone:610-434-1269
Mailing Address - Fax:610-432-4083
Practice Address - Street 1:1230 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6212
Practice Address - Country:US
Practice Address - Phone:610-434-1269
Practice Address - Fax:610-432-4083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033817E2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA098663Medicare ID - Type Unspecified
PAB37508Medicare UPIN