Provider Demographics
NPI:1245329747
Name:WILLIAMSBURG PLASTIC SURGERY PC
Entity type:Organization
Organization Name:WILLIAMSBURG PLASTIC SURGERY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNSTUART
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUARNIERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-345-2275
Mailing Address - Street 1:333 MCLAWS CIR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-6339
Mailing Address - Country:US
Mailing Address - Phone:757-345-2275
Mailing Address - Fax:757-229-3435
Practice Address - Street 1:333 MCLAWS CIR
Practice Address - Street 2:SUITE 3
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-6339
Practice Address - Country:US
Practice Address - Phone:757-345-2275
Practice Address - Fax:757-229-3435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041390208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08294Medicare PIN