Healthcare Provider Details

I. General information

NPI: 1104037779
Provider Name (Legal Business Name): TARRANT PLASTIC SURGERY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 18TH ST STE 310
PARKERSBURG WV
26101-3235
US

IV. Provider business mailing address

600 18TH ST STE 310
PARKERSBURG WV
26101-3235
US

V. Phone/Fax

Practice location:
  • Phone: 304-424-4880
  • Fax: 304-424-4965
Mailing address:
  • Phone: 304-424-4880
  • Fax: 304-424-4965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number15427
License Number StateWV

VIII. Authorized Official

Name: DR. LAWRENCE W TARRANT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 304-424-4880