Provider Demographics
NPI:1023245966
Name:NIRVANA PLASTIC SURGERY, P.A.
Entity type:Organization
Organization Name:NIRVANA PLASTIC SURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-839-2004
Mailing Address - Street 1:8208A DEVON CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4178
Mailing Address - Country:US
Mailing Address - Phone:843-839-2004
Mailing Address - Fax:843-839-2011
Practice Address - Street 1:8208A DEVON CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4178
Practice Address - Country:US
Practice Address - Phone:843-839-2004
Practice Address - Fax:843-839-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31460208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty