Healthcare Provider Details

I. General information

NPI: 1982182721
Provider Name (Legal Business Name): CAPITAL FACIAL PLASTIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WISCONSIN CIR STE 820
CHEVY CHASE MD
20815-7033
US

IV. Provider business mailing address

7109 44TH ST
CHEVY CHASE MD
20815-6038
US

V. Phone/Fax

Practice location:
  • Phone: 240-630-8449
  • Fax: 240-235-2255
Mailing address:
  • Phone: 240-630-8449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberD84808
License Number StateMD

VIII. Authorized Official

Name: ADAM E SINGLETON
Title or Position: SOLE MEMBER
Credential: MD
Phone: 240-630-8449