Healthcare Provider Details

I. General information

NPI: 1336487180
Provider Name (Legal Business Name): BOTTICELLI CENTER FOR AESTHETIC PLASTIC SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 CHAIN BRIDGE RD
MC LEAN VA
22101-3935
US

IV. Provider business mailing address

1300 CHAIN BRIDGE RD
MC LEAN VA
22101-3935
US

V. Phone/Fax

Practice location:
  • Phone: 703-790-5454
  • Fax: 703-790-9184
Mailing address:
  • Phone: 703-790-5454
  • Fax: 703-790-9184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CSABA L MAGASST
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 703-790-5454