Provider Demographics
NPI:1841325214
Name:AMBULATORY CENTER FOR AESTHETIC AND RECONSTRUCTIVE SURGERY
Entity type:Organization
Organization Name:AMBULATORY CENTER FOR AESTHETIC AND RECONSTRUCTIVE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:ALBERTOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-698-9999
Mailing Address - Street 1:56 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4599
Mailing Address - Country:US
Mailing Address - Phone:301-698-9999
Mailing Address - Fax:
Practice Address - Street 1:56 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4599
Practice Address - Country:US
Practice Address - Phone:301-698-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD229ZMedicare PIN