Healthcare Provider Details

I. General information

NPI: 1285578658
Provider Name (Legal Business Name): MID ATLANTIC PLASTIC & RECONSTRUCTIVE SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 THOMAS JOHNSON DR STE 100
FREDERICK MD
21702-4860
US

IV. Provider business mailing address

56 THOMAS JOHNSON DR STE 100
FREDERICK MD
21702-4860
US

V. Phone/Fax

Practice location:
  • Phone: 301-378-2015
  • Fax: 301-662-4011
Mailing address:
  • Phone: 301-378-2015
  • Fax: 301-662-4011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SARAH SOFLEY
Title or Position: REGISTERED NURSE
Credential: RN
Phone: 301-639-0312