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General NPI Number Information
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NPI Number | 1902010309
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Entity Type | Organization
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Legal Business Name | RENAISSANCE PLASTIC SURGERY GROUP LLC
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 1350 LOCUST ST G103
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City | PITTSBURGH
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State | PA
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Zip | 15219-4738
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Country | US
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Telephone | 412-232-8089
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Fax | 412-232-8340
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Provider Business Mailing Address
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Address Line | PO BOX 101836
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City | PITTSBURGH
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State | PA
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Zip | 15237-0836
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Country | US
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Telephone | 412-232-8089
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Fax | 412-232-8340
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Authorized Official
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Title or Position | CEO
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Name | DR. GUY M STOFMAN
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Credential | MD
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Telephone | 412-232-8089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD034789E
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License Number State | PA
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