Healthcare Provider Details

I. General information

NPI: 1346205135
Provider Name (Legal Business Name): STILLWATER PLASTIC SURGERY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8712 LINDHOLM DR SUITE 308
HUNTERSVILLE NC
28078-1870
US

IV. Provider business mailing address

8712 LINDHOLM DR SUITE 308
HUNTERSVILLE NC
28078-1870
US

V. Phone/Fax

Practice location:
  • Phone: 704-655-8988
  • Fax: 704-655-8980
Mailing address:
  • Phone: 704-655-8988
  • Fax: 704-655-8980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number9700210
License Number StateNC

VIII. Authorized Official

Name: PETER JOSEPH CAPIZZI
Title or Position: MGR
Credential: MD
Phone: 704-655-8988