Provider Demographics
NPI:1457564213
Name:BANDAK PLASTIC SURGERY PLLC
Entity Type:Organization
Organization Name:BANDAK PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDALLA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:BANDAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-925-4665
Mailing Address - Street 1:4920 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2052
Mailing Address - Country:US
Mailing Address - Phone:304-925-4665
Mailing Address - Fax:304-925-4666
Practice Address - Street 1:4920 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2052
Practice Address - Country:US
Practice Address - Phone:304-925-4665
Practice Address - Fax:304-925-4666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV218392086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty