Provider Demographics
NPI:1649516998
Name:CAPITAL PLASTIC SURGEONS
Entity type:Organization
Organization Name:CAPITAL PLASTIC SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-263-0800
Mailing Address - Street 1:7601 LEWINSVILLE RD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2814
Mailing Address - Country:US
Mailing Address - Phone:855-594-6224
Mailing Address - Fax:717-620-8720
Practice Address - Street 1:7601 LEWINSVILLE RD
Practice Address - Street 2:SUITE 440
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-2814
Practice Address - Country:US
Practice Address - Phone:855-594-6224
Practice Address - Fax:717-620-8720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty