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General NPI Number Information
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NPI Number | 1427088731
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Entity Type | Organization
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Legal Business Name | LE VISAGE ENT & FACIAL PLASTIC
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 6410 ROCKLEDGE DR #650
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City | BETHESDA
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State | MD
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Zip | 20817-1809
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Country | US
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Telephone | 301-897-5858
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Fax | 301-897-5860
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Provider Business Mailing Address
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Address Line | 6410 ROCKLEDGE DR #650
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City | BETHESDA
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State | MD
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Zip | 20817-1809
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Country | US
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Telephone | 301-897-5858
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Fax | 301-897-5860
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Authorized Official
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Title or Position | OWNER
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Name | DUANE JON TAYLOR
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Credential | MD
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Telephone | 301-897-5858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D00040031
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License Number State | MD
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