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General NPI Number Information
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NPI Number | 1891976650
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Entity Type | Organization
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Legal Business Name | THE CENTERS FOR PLASTIC SURGERY
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 06/24/2010
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Provider Practice Location Address
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Address Line | 2880 KEAGY RD
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City | SALEM
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State | VA
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Zip | 24153-7458
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Country | US
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Telephone | 540-444-4343
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Fax | 540-444-4345
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Provider Business Mailing Address
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Address Line | PO BOX 4127
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City | ROANOKE
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State | VA
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Zip | 24015-0127
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Country | US
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Telephone | 540-981-9394
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Fax | 540-344-7154
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Authorized Official
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Title or Position | OWNER
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Name | CAROL A WRAY
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Credential | MD
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Telephone | 540-444-4343
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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 | 0101042617
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License Number State | VA
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