Healthcare Provider Details

I. General information

NPI: 1780314997
Provider Name (Legal Business Name): RECONSTRUCTIVE SURGICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 DENNISON AVE STE 200
COLUMBUS OH
43201-3631
US

IV. Provider business mailing address

1020 DENNISON AVE STE 200
COLUMBUS OH
43201-3631
US

V. Phone/Fax

Practice location:
  • Phone: 614-618-9018
  • Fax: 614-368-1403
Mailing address:
  • Phone: 614-618-9018
  • Fax: 614-368-1403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER DAVID MCCLUNG
Title or Position: PHYSICIAN / OWNER
Credential: MD
Phone: 614-315-0624