=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093908923
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMBULATORY PLASTIC SURGERY CENTER ASSOCIATES, CHARTERED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2007
-----------------------------------------------------
Last Update Date | 03/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15245 SHADY GROVE RD SUITE 155
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20850-3222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-912-4708
-----------------------------------------------------
Fax | 240-912-6992
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15245 SHADY GROVE RD SUITE 155
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20850-3222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-912-4708
-----------------------------------------------------
Fax | 240-912-6992
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MICHAEL PAUL VINCENT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 240-912-4708
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------