Healthcare Provider Details

I. General information

NPI: 1316235948
Provider Name (Legal Business Name): DAVINCI PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 NEW MEXICO AVE NW STE 236
WASHINGTON DC
20016-3610
US

IV. Provider business mailing address

3301 NEW MEXICO AVE NW STE 236
WASHINGTON DC
20016-3610
US

V. Phone/Fax

Practice location:
  • Phone: 202-966-9590
  • Fax:
Mailing address:
  • Phone: 202-966-9590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LINSEY GRINDLE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 202-966-9590