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General NPI Number Information
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NPI Number | 1639490519
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Entity Type | Organization
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Legal Business Name | COSMETIC PLASTIC SURGERY AND LASER CENTER LLC
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Dates
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Enumeration Date | 06/15/2010
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Last Update Date | 05/02/2022
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Provider Practice Location Address
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Address Line | 49 ST. PAUL DRIVE
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City | CHAMBERSBURG
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State | PA
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Zip | 17201
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Country | US
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Telephone | 717-261-1620
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Fax | 717-261-5912
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Provider Business Mailing Address
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Address Line | 49 ST PAUL DR
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City | CHAMBERSBURG
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State | PA
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Zip | 17201-1020
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Country | US
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Telephone | 717-261-1620
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Fax | 717-261-5912
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Authorized Official
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Title or Position | PRESIDENT
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Name | SALVATORE DIMERCURIO
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Credential | M.D.
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Telephone | 301-714-4466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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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 | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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