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General NPI Number Information
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NPI Number | 1598820136
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Entity Type | Organization
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Legal Business Name | PRESTIGE PLASTIC SURGERY, LLC
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 8600 SNOWDEN RIVER PKWY SUITE 308
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City | COLUMBIA
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State | MD
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Zip | 21045-1982
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Country | US
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Telephone | 410-290-1696
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Fax |
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Provider Business Mailing Address
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Address Line | 8600 SNOWDEN RIVER PKWY SUITE 308
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City | COLUMBIA
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State | MD
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Zip | 21045-1982
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Country | US
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Telephone | 410-290-1696
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY ANTHONY VELA
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Credential | M.D.
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Telephone | 410-290-1696
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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 | D0063900
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License Number State | MD
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