Provider Demographics
NPI:1902121528
Name:NOWICKY PLASTIC SURGERY, PA
Entity Type:Organization
Organization Name:NOWICKY PLASTIC SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORIARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-947-3331
Mailing Address - Street 1:PO BOX 1644
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28070-1644
Mailing Address - Country:US
Mailing Address - Phone:704-947-3331
Mailing Address - Fax:704-766-3426
Practice Address - Street 1:19620 W CATAWBA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-4052
Practice Address - Country:US
Practice Address - Phone:704-947-3331
Practice Address - Fax:704-766-3426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty