Provider Demographics
NPI:1730362864
Name:PLASTIC SURGERY OF SOUTHERN MARYLAND, P.A.
Entity type:Organization
Organization Name:PLASTIC SURGERY OF SOUTHERN MARYLAND, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:EHRMANTRAUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-414-9844
Mailing Address - Street 1:110 HOSPITAL RD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4019
Mailing Address - Country:US
Mailing Address - Phone:410-414-9844
Mailing Address - Fax:410-414-9795
Practice Address - Street 1:110 HOSPITAL RD
Practice Address - Street 2:SUITE 213
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4019
Practice Address - Country:US
Practice Address - Phone:410-414-9844
Practice Address - Fax:410-414-9795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059299208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H71207Medicare UPIN
MD447MMedicare PIN