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General NPI Number Information
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NPI Number | 1366930299
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Entity Type | Organization
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Legal Business Name | CARDINAL PLASTIC SURGERY PLLC
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Dates
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Enumeration Date | 04/26/2018
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Last Update Date | 09/19/2018
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Provider Practice Location Address
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Address Line | 300 MEDICAL PKWY STE 300
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4985
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Country | US
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Telephone | 757-389-5505
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Fax | 757-389-5504
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Provider Business Mailing Address
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Address Line | 300 MEDICAL PKWY STE 300
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4985
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Country | US
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Telephone | 757-389-5505
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Fax | 757-389-5504
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Authorized Official
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Title or Position | PRESIDENT
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Name | JULIA STEVENSON
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Credential | MD
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Telephone | 717-421-5564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 0101263805
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License Number State | VA
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