Healthcare Provider Details

I. General information

NPI: 1013997204
Provider Name (Legal Business Name): BLAIR COUNTY PLASTIC SURGERY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 12/04/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 HAWTHORNE DR SUITE 100
HOLLIDAYSBURG PA
16648
US

IV. Provider business mailing address

601 HAWTHORNE DR SUITE 100
HOLLIDAYSBURG PA
16648
US

V. Phone/Fax

Practice location:
  • Phone: 814-949-7280
  • Fax: 814-949-7283
Mailing address:
  • Phone: 814-949-7280
  • Fax: 814-949-7283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMD045155E
License Number StatePA

VIII. Authorized Official

Name: DR. ROBERT BRIAN LOUTON
Title or Position: OWNER
Credential: MD
Phone: 814-949-7280