Healthcare Provider Details

I. General information

NPI: 1083802847
Provider Name (Legal Business Name): THE CENTER FOR PLASTIC SURGERY AT RIDGEWOOD HILL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 KEAGY RD
SALEM VA
24153-7458
US

IV. Provider business mailing address

PO BOX 4127
SALEM VA
24153
US

V. Phone/Fax

Practice location:
  • Phone: 540-444-4343
  • Fax: 540-444-4345
Mailing address:
  • Phone: 540-981-9394
  • Fax: 540-344-7154

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: CAROL A WRAY
Title or Position: OWNER
Credential: MD
Phone: 540-444-4343