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General NPI Number Information
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NPI Number | 1821473760
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Entity Type | Organization
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Legal Business Name | PLASTIC SURGERY SPECIALISTS
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Dates
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Enumeration Date | 07/21/2015
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 260 MCLAWS CIR
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-5650
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Country | US
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Telephone | 757-345-5599
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Fax | 757-345-5516
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Provider Business Mailing Address
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Address Line | 260 MCLAWS CIR
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-5650
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Country | US
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Telephone | 757-345-5599
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Fax | 757-345-5516
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROGER E EMORY
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Credential | M.D.
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Telephone | 757-345-5599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 0101840454
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License Number State | VA
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