Healthcare Provider Details

I. General information

NPI: 1992964811
Provider Name (Legal Business Name): GERMAIN PLASTIC SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 BEVERLY RD SUITE 220
MC LEAN VA
22101-3651
US

IV. Provider business mailing address

1355 BEVERLY RD SUITE 220
MC LEAN VA
22101-3651
US

V. Phone/Fax

Practice location:
  • Phone: 703-442-8040
  • Fax: 703-992-8354
Mailing address:
  • Phone: 703-442-8040
  • Fax: 703-992-8354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101238468
License Number StateVA

VIII. Authorized Official

Name: DR. TIMOTHY JUSTIN GERMAIN
Title or Position: PLASTIC SURGEON
Credential: MD
Phone: 703-442-8040