Healthcare Provider Details

I. General information

NPI: 1982424388
Provider Name (Legal Business Name): AESTHETIC MEDICINE AND SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3300
US

IV. Provider business mailing address

PO BOX 4
MC LEAN VA
22101-0004
US

V. Phone/Fax

Practice location:
  • Phone: 443-646-5001
  • Fax: 410-257-7042
Mailing address:
  • Phone: 443-646-5001
  • Fax: 410-257-7042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GABRIEL F SANTIAGO
Title or Position: PRESIDENT
Credential: MD, MBA
Phone: 443-646-5001