Healthcare Provider Details

I. General information

NPI: 1184467847
Provider Name (Legal Business Name): PRIME FACIAL PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10285 LITTLE PATUXENT PKWY STE 250
COLUMBIA MD
21044-3412
US

IV. Provider business mailing address

6050 BRICKER RD
DAYTON MD
21036-1248
US

V. Phone/Fax

Practice location:
  • Phone: 301-302-7272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JIGAR SITAPARA
Title or Position: CEO
Credential: MD
Phone: 301-301-7272