Provider Demographics
NPI:1013490267
Name:DC PLASTIC SURGERY BOUTIQUE LLC
Entity Type:Organization
Organization Name:DC PLASTIC SURGERY BOUTIQUE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KULKARNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-599-3649
Mailing Address - Street 1:1840 47TH PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-1909
Mailing Address - Country:US
Mailing Address - Phone:202-599-3649
Mailing Address - Fax:
Practice Address - Street 1:2440 M ST NW STE 318
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1472
Practice Address - Country:US
Practice Address - Phone:202-335-4700
Practice Address - Fax:925-993-1234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty