Provider Demographics
NPI:1184467847
Name:PRIME FACIAL PLASTIC SURGERY
Entity type:Organization
Organization Name:PRIME FACIAL PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JIGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SITAPARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-301-7272
Mailing Address - Street 1:6050 BRICKER RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:MD
Mailing Address - Zip Code:21036-1248
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10285 LITTLE PATUXENT PKWY STE 250
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3412
Practice Address - Country:US
Practice Address - Phone:301-302-7272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty