Provider Demographics
NPI:1538128483
Name:COSMETIC AND PLASTIC SURGERY SPECIALISTS PC
Entity type:Organization
Organization Name:COSMETIC AND PLASTIC SURGERY SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HALLENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-257-7195
Mailing Address - Street 1:PO BOX 11768
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-0168
Mailing Address - Country:US
Mailing Address - Phone:804-672-4811
Mailing Address - Fax:804-213-9783
Practice Address - Street 1:2621 GROVE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4308
Practice Address - Country:US
Practice Address - Phone:804-257-7195
Practice Address - Fax:804-254-5314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B06648Medicare UPIN
240000257Medicare ID - Type Unspecified
VAGC1196Medicare PIN