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General NPI Number Information
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NPI Number | 1881925311
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Entity Type | Organization
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Legal Business Name | RECONSTRUCTIVE PLASTIC SURGERY CONSULTANTS, LLC
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Dates
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Enumeration Date | 01/22/2010
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Last Update Date | 01/22/2010
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Provider Practice Location Address
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Address Line | 3289 WOODBURN RD SUITE 245
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City | ANNANDALE
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State | VA
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Zip | 22003-6800
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Country | US
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Telephone | 703-645-0077
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Fax | 703-645-0130
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Provider Business Mailing Address
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Address Line | 3289 WOODBURN RD SUITE 245
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City | ANNANDALE
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State | VA
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Zip | 22003
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Country | US
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Telephone | 703-645-0077
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. REZA MIRALIAKBARI
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Credential | M.D.
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Telephone | 703-645-0077
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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 | 101243338
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License Number State | VA
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