Provider Demographics
NPI:1902899289
Name:LEWISBURG PLASTIC SURGERY AND LASER CENTER
Entity Type:Organization
Organization Name:LEWISBURG PLASTIC SURGERY AND LASER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:NORMINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-524-7777
Mailing Address - Street 1:135 WALTER DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-7482
Mailing Address - Country:US
Mailing Address - Phone:570-524-7777
Mailing Address - Fax:570-523-9165
Practice Address - Street 1:135 WALTER DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-7482
Practice Address - Country:US
Practice Address - Phone:570-524-7777
Practice Address - Fax:570-523-9165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA28421501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA081112Medicare ID - Type Unspecified
PA081112Medicare UPIN