Healthcare Provider Details

I. General information

NPI: 1558692491
Provider Name (Legal Business Name): NATIONAL CENTER FOR PLASTIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 LEWINSVILLE RD STE 400
MC LEAN VA
22102-2814
US

IV. Provider business mailing address

7601 LEWINSVILLE RD STE 400
MC LEAN VA
22102-2814
US

V. Phone/Fax

Practice location:
  • Phone: 703-287-8277
  • Fax: 703-287-8278
Mailing address:
  • Phone: 703-287-8277
  • Fax: 703-287-8278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101233860
License Number StateVA

VIII. Authorized Official

Name: MARK L VENTURI
Title or Position: PHYSICIAN
Credential: MD
Phone: 703-287-8277