Healthcare Provider Details

I. General information

NPI: 1821156647
Provider Name (Legal Business Name): PLASTIC SURGERY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 CHAIN BRIDGE RD
MCLEAN VA
22101
US

IV. Provider business mailing address

1300 CHAIN BRIDGE RD
MCLEAN VA
22101
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 Number0101019730
License Number StateVI

VIII. Authorized Official

Name: MS. CATHERINE RONCAL
Title or Position: ACCOUNTING
Credential:
Phone: 703-790-5454