Healthcare Provider Details

I. General information

NPI: 1245329747
Provider Name (Legal Business Name): WILLIAMSBURG PLASTIC SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 MCLAWS CIR SUITE 3
WILLIAMSBURG VA
23185-6339
US

IV. Provider business mailing address

333 MCLAWS CIR SUITE 3
WILLIAMSBURG VA
23185-6339
US

V. Phone/Fax

Practice location:
  • Phone: 757-345-2275
  • Fax: 757-229-3435
Mailing address:
  • Phone: 757-345-2275
  • Fax: 757-229-3435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101041390
License Number StateVA

VIII. Authorized Official

Name: DR. JOHNSTUART M GUARNIERI
Title or Position: OWNER
Credential: M.D.
Phone: 757-345-2275