=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376068577
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONGRESSIONAL PLASTIC SURGERY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2017
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8501 ARLINGTON BLVD STE 310
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22031-4625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-945-1700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6101 CROMWELL DR
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20816-3411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-945-1700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. CHRISTOPHER CHANG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 703-945-1700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | 0101257925
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------