Healthcare Provider Details

I. General information

NPI: 1386650059
Provider Name (Legal Business Name): NORTHERN VIRGINIA CENTER FOR FACIAL PLASTIC SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8180 GREENSBORO DR SUITE #1015
MCLEAN VA
22102-3888
US

IV. Provider business mailing address

8180 GREENSBORO DR SUITE #1015
MCLEAN VA
22102-3888
US

V. Phone/Fax

Practice location:
  • Phone: 703-790-5700
  • Fax: 703-827-8730
Mailing address:
  • Phone: 703-790-5700
  • Fax: 703-827-8730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number0101053960
License Number StateVA

VIII. Authorized Official

Name: WILLIAM LINDSEY
Title or Position: PHYSICIAN OWNER
Credential:
Phone: 703-790-5709