Provider Demographics
NPI:1548453590
Name:PLASTIC SURGERY, P.A.
Entity type:Organization
Organization Name:PLASTIC SURGERY, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-715-9205
Mailing Address - Street 1:5092 DORSEY HALL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7894
Mailing Address - Country:US
Mailing Address - Phone:410-715-9205
Mailing Address - Fax:410-715-9208
Practice Address - Street 1:5092 DORSEY HALL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7894
Practice Address - Country:US
Practice Address - Phone:410-715-9205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
228LMedicare PIN