Provider Demographics
NPI:1982313524
Name:BESPOKE AESTHETIC PLASTIC SURGERY
Entity Type:Organization
Organization Name:BESPOKE AESTHETIC PLASTIC SURGERY
Other - Org Name:BESPOKE PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NADYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-257-1619
Mailing Address - Street 1:9601 BLACKWELL RD STE 260
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6487
Mailing Address - Country:US
Mailing Address - Phone:301-500-0215
Mailing Address - Fax:301-238-7807
Practice Address - Street 1:9601 BLACKWELL RD STE 260
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6487
Practice Address - Country:US
Practice Address - Phone:301-500-0215
Practice Address - Fax:301-238-7807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-22
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty