Provider Demographics
NPI:1780954362
Name:MAIN LINE PLASTIC SURGERY P.C.
Entity type:Organization
Organization Name:MAIN LINE PLASTIC SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-222-0010
Mailing Address - Street 1:945 E HAVERFORD RD SUITE 102
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010
Mailing Address - Country:US
Mailing Address - Phone:484-222-0010
Mailing Address - Fax:
Practice Address - Street 1:945 E HAVERFORD RD STE 102
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3814
Practice Address - Country:US
Practice Address - Phone:484-222-0010
Practice Address - Fax:484-388-4388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty