Provider Demographics
NPI:1902838469
Name:COLUMBIA AESTHETIC PLASTIC SURGERY
Entity Type:Organization
Organization Name:COLUMBIA AESTHETIC PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-740-9330
Mailing Address - Street 1:8860 COLUMBIA 100 PKWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2195
Mailing Address - Country:US
Mailing Address - Phone:410-740-9330
Mailing Address - Fax:410-740-9335
Practice Address - Street 1:8860 COLUMBIA 100 PKWY
Practice Address - Street 2:SUITE 206
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2195
Practice Address - Country:US
Practice Address - Phone:410-740-9330
Practice Address - Fax:410-740-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062685208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD271PMedicare PIN