Healthcare Provider Details

I. General information

NPI: 1306087283
Provider Name (Legal Business Name): ELITE PLASTIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 CEDAR LN SUITE 301
VIENNA VA
22182-5202
US

IV. Provider business mailing address

PO BOX 685
DUNN LORING VA
22027-0685
US

V. Phone/Fax

Practice location:
  • Phone: 703-778-6000
  • Fax: 703-485-2989
Mailing address:
  • Phone: 703-778-6000
  • Fax: 703-485-2989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LYNN SABA
Title or Position: BUSINESS MANAGER
Credential:
Phone: 703-778-6000