Provider Demographics
NPI:1255449872
Name:MAGEE-ROSENBLUM PLASTIC SURGERY, INC
Entity type:Organization
Organization Name:MAGEE-ROSENBLUM PLASTIC SURGERY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-496-5556
Mailing Address - Street 1:1817 REPUBLIC RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-4543
Mailing Address - Country:US
Mailing Address - Phone:757-496-5556
Mailing Address - Fax:757-496-4939
Practice Address - Street 1:1817 REPUBLIC RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4543
Practice Address - Country:US
Practice Address - Phone:757-496-5556
Practice Address - Fax:757-496-4939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2023-04-12
Deactivation Date:2022-08-02
Deactivation Code:
Reactivation Date:2022-09-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06285Medicare ID - Type Unspecified