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General NPI Number Information
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NPI Number | 1558692491
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Entity Type | Organization
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Legal Business Name | NATIONAL CENTER FOR PLASTIC SURGERY LLC
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Dates
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Enumeration Date | 01/15/2010
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Last Update Date | 01/15/2010
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Provider Practice Location Address
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Address Line | 7601 LEWINSVILLE RD STE 400
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City | MC LEAN
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State | VA
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Zip | 22102-2814
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Country | US
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Telephone | 703-287-8277
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Fax | 703-287-8278
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Provider Business Mailing Address
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Address Line | 7601 LEWINSVILLE RD STE 400
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City | MC LEAN
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State | VA
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Zip | 22102-2814
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Country | US
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Telephone | 703-287-8277
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Fax | 703-287-8278
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MARK L VENTURI
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Credential | MD
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Telephone | 703-287-8277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101233860
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License Number State | VA
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