Healthcare Provider Details

I. General information

NPI: 1902838469
Provider Name (Legal Business Name): COLUMBIA AESTHETIC PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8860 COLUMBIA 100 PKWY STE 314
COLUMBIA MD
21045-2298
US

IV. Provider business mailing address

8860 COLUMBIA 100 PKWY STE 314
COLUMBIA MD
21045-2298
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-9330
  • Fax: 410-740-9335
Mailing address:
  • Phone: 410-740-9330
  • Fax: 410-740-9335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC CHANG
Title or Position: OWNER
Credential: MD
Phone: 410-740-9330