=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942380993
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COSMETIC SURGERY CENTER OF LANCASTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2006
-----------------------------------------------------
Last Update Date | 04/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2110 HARRISBURG PIKE SUITE 210
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17601-2644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-291-5863
-----------------------------------------------------
Fax | 717-392-6915
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2110 HARRISBURG PIKE SUITE 210
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17601-2644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-291-5863
-----------------------------------------------------
Fax | 717-392-6915
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. SUSAN FUHRMAN
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 717-291-5863
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------