Provider Demographics
NPI:1134619166
Name:AESTHETIC CENTER FOR PLASTIC SURGERY
Entity type:Organization
Organization Name:AESTHETIC CENTER FOR PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-893-1111
Mailing Address - Street 1:6845 ELM ST STE 708
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3851
Mailing Address - Country:US
Mailing Address - Phone:703-893-1111
Mailing Address - Fax:703-760-9565
Practice Address - Street 1:6845 ELM ST STE 708
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3851
Practice Address - Country:US
Practice Address - Phone:703-893-1111
Practice Address - Fax:703-760-9565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010393852086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty