Healthcare Provider Details

I. General information

NPI: 1063316362
Provider Name (Legal Business Name): IKON PLASTIC SURGERY AND MEDICAL AESTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WISCONSIN CIR STE 615
CHEVY CHASE MD
20815-7003
US

IV. Provider business mailing address

2 WISCONSIN CIR STE 615
CHEVY CHASE MD
20815-7003
US

V. Phone/Fax

Practice location:
  • Phone: 301-800-7762
  • Fax: 301-800-7776
Mailing address:
  • Phone: 301-800-7762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAMES ECONOMIDES
Title or Position: PRESIDENT AND CEO
Credential: MD
Phone: 301-922-9538