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NPI Code Detail

MEDICARE: PLASTIC SURGERY OF NORTH CENTRAL OHIO, LLC

MEDICARE: PLASTIC SURGERY OF NORTH CENTRAL OHIO, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208200000XPlastic Surgery Physician35-056696OH

General Provider Information

NPI Number : 1477593994
Entity Type Code : Organization
Provider Name (Legal Business Name) : PLASTIC SURGERY OF NORTH CENTRAL OHIO, LLC
Provider Business Mailing Address
First Line : 278 BENEDICT AVENUE
Second Line : BUILDING 3, SUITE 450
City : NORWALK
State : OH
Zip : 44857-2399
Country : US
Telephone Number : 419-668-7010
Fax Number : 419-668-7006
Provider Business Practice Location Address
First Line : 278 BENEDICT AVENUE
Second Line : BUILDING 3, SUITE 450
City : NORWALK
State : OH
Zip : 44857-2399
Country : US
Telephone Number : 419-668-7010
Fax Number : 419-668-7006
Authorized Official
Title or Position : PRESIDENT
Name : TERESA GHAZOUL
Credential : M.D.
Telephone Number : 419-668-7010
Provider Enumeration Date : 06/07/2006
Last Update Date : 11/17/2009

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Directions to “PLASTIC SURGERY OF NORTH CENTRAL OHIO, LLC ” Practice Location

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