Healthcare Provider Details

I. General information

NPI: 1992074967
Provider Name (Legal Business Name): SHENANDOAH PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1836 W PLAZA DR
WINCHESTER VA
22601-6365
US

IV. Provider business mailing address

1836 W PLAZA DR
WINCHESTER VA
22601-6365
US

V. Phone/Fax

Practice location:
  • Phone: 540-722-2280
  • Fax: 540-722-0763
Mailing address:
  • Phone: 540-722-2280
  • Fax: 540-722-0763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101052328
License Number StateVA

VIII. Authorized Official

Name: DR. PAUL A LAMBERT
Title or Position: OWNER
Credential: M. D,
Phone: 540-722-2280