Provider Demographics
NPI:1851794283
Name:COSMETIC AND PLASTIC SURGERY OF CENTRAL PENNSYLVANIA, LLC
Entity Type:Organization
Organization Name:COSMETIC AND PLASTIC SURGERY OF CENTRAL PENNSYLVANIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLASTIC SURGEON/MEMBER, SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:T
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-873-1526
Mailing Address - Street 1:425 N 21ST ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2223
Mailing Address - Country:US
Mailing Address - Phone:717-695-6553
Mailing Address - Fax:855-383-3233
Practice Address - Street 1:425 N 21ST ST
Practice Address - Street 2:SUITE 405
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2223
Practice Address - Country:US
Practice Address - Phone:717-695-6553
Practice Address - Fax:855-383-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD438302208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty