MEDICARE: BEL AIR CENTER FOR PLASTIC AND HAND SURGERY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XH1200X	Hand Occupational Therapist	04344	MD
2	225X00000X	Occupational Therapist	02803	MD
3	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician	D0058273	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043432297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEL AIR CENTER FOR PLASTIC AND HAND SURGERY

Provider Business Mailing Address
First Line	:	PO BOX 845
Second Line	:
City	:	BEL AIR
State	:	MD
Zip	:	21014-0845
Country	:	US
Telephone Number	:	410-569-5155
Fax Number	:	410-569-5166

Provider Business Practice Location Address
First Line	:	2012 S TOLLGATE RD
Second Line	:	SUITE 100
City	:	BEL AIR
State	:	MD
Zip	:	21015-5900
Country	:	US
Telephone Number	:	410-569-5155
Fax Number	:	410-569-5166

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JENNIE L CAO
Credential	:
Telephone Number	:	410-569-5155

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	02/11/2013

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Directions to “BEL AIR CENTER FOR PLASTIC AND HAND SURGERY ” Practice Location

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