Healthcare Provider Details

I. General information

NPI: 1427088731
Provider Name (Legal Business Name): LE VISAGE ENT & FACIAL PLASTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 ROCKLEDGE DR #650
BETHESDA MD
20817-1809
US

IV. Provider business mailing address

6410 ROCKLEDGE DR #650
BETHESDA MD
20817-1809
US

V. Phone/Fax

Practice location:
  • Phone: 301-897-5858
  • Fax: 301-897-5860
Mailing address:
  • Phone: 301-897-5858
  • Fax: 301-897-5860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD00040031
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DUANE JON TAYLOR
Title or Position: OWNER
Credential: MD
Phone: 301-897-5858