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General NPI Number Information
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NPI Number | 1124036843
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Entity Type | Organization
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Legal Business Name | COSMETIC SURGERY CENTER FOR WOMEN
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 396 SOUTH WITCHDUCK RD SUITE 100
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462
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Country | US
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Telephone | 757-497-5400
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Fax | 757-497-8811
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Provider Business Mailing Address
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Address Line | 396 SOUTH WITCHDUCK RD SUITE 100
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462
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Country | US
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Telephone | 757-497-5400
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Fax | 757-497-8811
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOANN LOPES
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Credential | MD
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Telephone | 757-497-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 0101051490
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License Number State | VA
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