MEDICARE: WILLIAMSBURG PLASTIC SURGERY PC

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	208200000X	Plastic Surgery Physician	0101041390	VA

General Provider Information

NPI Number	:	1245329747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAMSBURG PLASTIC SURGERY PC

Provider Business Mailing Address
First Line	:	333 MCLAWS CIR
Second Line	:	SUITE 3
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-6339
Country	:	US
Telephone Number	:	757-345-2275
Fax Number	:	757-229-3435

Provider Business Practice Location Address
First Line	:	333 MCLAWS CIR
Second Line	:	SUITE 3
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-6339
Country	:	US
Telephone Number	:	757-345-2275
Fax Number	:	757-229-3435

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHNSTUART M GUARNIERI
Credential	:	M.D.
Telephone Number	:	757-345-2275

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	03/08/2012

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