Healthcare Provider Details

I. General information

NPI: 1770727463
Provider Name (Legal Business Name): AESTHETIC CENTER FOR COSMETIC AND PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 MCLAWS CIRCLE SUITE 3
WILLIAMSBURG VA
23185
US

IV. Provider business mailing address

333 MCLAWS CIRCLE
WILLIAMSBURG VA
23185
US

V. Phone/Fax

Practice location:
  • Phone: 757-345-0069
  • Fax: 757-229-3435
Mailing address:
  • Phone: 757-345-0069
  • Fax: 757-229-3435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101041390
License Number StateVA

VIII. Authorized Official

Name: DR. JOHNSTUART MAXWELL GUARNIERI
Title or Position: DOCTOR/CEO
Credential: M.D.
Phone: 757-345-0069