Provider Demographics
NPI:1770727463
Name:AESTHETIC CENTER FOR COSMETIC AND PLASTIC SURGERY
Entity type:Organization
Organization Name:AESTHETIC CENTER FOR COSMETIC AND PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNSTUART
Authorized Official - Middle Name:MAXWELL
Authorized Official - Last Name:GUARNIERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-345-0069
Mailing Address - Street 1:333 MCLAWS CIRCLE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185
Mailing Address - Country:US
Mailing Address - Phone:757-345-0069
Mailing Address - Fax:757-229-3435
Practice Address - Street 1:333 MCLAWS CIRCLE
Practice Address - Street 2:SUITE 3
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185
Practice Address - Country:US
Practice Address - Phone:757-345-0069
Practice Address - Fax:757-229-3435
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AESTHETIC CENTER FOR COSMETIC AND PLASTIC SURGERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041390208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
292271OtherANTHEM PROVIDER #
VA6901913Medicaid
292270OtherACCPS GROUP
351753OtherACCPS
240000275Medicare UPIN