Healthcare Provider Details

I. General information

NPI: 1033734595
Provider Name (Legal Business Name): MAIA PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 BOONE BOULEVARD SUITE 730
TYSONS CORNER VA
22182-2688
US

IV. Provider business mailing address

8300 GREENSBORO DR STE L1-180
MC LEAN VA
22102-3605
US

V. Phone/Fax

Practice location:
  • Phone: 703-574-4500
  • Fax: 443-949-7508
Mailing address:
  • Phone: 703-574-4500
  • Fax: 443-949-7508

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: MUNIQUE MAIA
Title or Position: PLASTIC SURGEON
Credential: M.D.
Phone: 703-574-4500