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General NPI Number Information
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NPI Number | 1346205135
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Entity Type | Organization
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Legal Business Name | STILLWATER PLASTIC SURGERY, PA
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 11/11/2008
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Provider Practice Location Address
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Address Line | 8712 LINDHOLM DR SUITE 308
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-1870
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Country | US
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Telephone | 704-655-8988
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Fax | 704-655-8980
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Provider Business Mailing Address
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Address Line | 8712 LINDHOLM DR SUITE 308
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-1870
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Country | US
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Telephone | 704-655-8988
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Fax | 704-655-8980
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Authorized Official
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Title or Position | MGR
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Name | PETER JOSEPH CAPIZZI
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Credential | MD
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Telephone | 704-655-8988
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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 | 9700210
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License Number State | NC
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