Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 S TOLLGATE RD SUITE 100
BEL AIR MD
21015-5900
US

IV. Provider business mailing address

PO BOX 845
BEL AIR MD
21014-0845
US

V. Phone/Fax

Practice location:
  • Phone: 410-569-5155
  • Fax: 410-569-5166
Mailing address:
  • Phone: 410-569-5155
  • Fax: 410-569-5166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberD0058273
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number02803
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number04344
License Number StateMD

VIII. Authorized Official

Name: JENNIE L CAO
Title or Position: OFFICE MANAGER
Credential:
Phone: 410-569-5155