Healthcare Provider Details

I. General information

NPI: 1912192717
Provider Name (Legal Business Name): SEWELL PLASTIC SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 MEADOWBRIDGE RD SUITE 304
MECHANICSVILLE VA
23116-2336
US

IV. Provider business mailing address

8220 MEADOWBRIDGE RD SUITE 304
MECHANICSVILLE VA
23116-2336
US

V. Phone/Fax

Practice location:
  • Phone: 804-427-7770
  • Fax:
Mailing address:
  • Phone: 804-427-7770
  • Fax: 804-548-4159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NATHAN A SEWELL
Title or Position: OWNER
Credential: MD
Phone: 804-427-7770