1336863844 NPI number — AFFILIATES IN PLASTIC SURGERY, LLC

Table of content: (NPI 1336863844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336863844 NPI number — AFFILIATES IN PLASTIC SURGERY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AFFILIATES IN PLASTIC SURGERY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SHADY GROVE SURGICENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336863844
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4660 KENMORE AVE STE 220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22304-1306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-832-4000
Provider Business Mailing Address Fax Number:
703-832-4001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15245 SHADY GROVE RD STE 155
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-6271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-232-3000
Provider Business Practice Location Address Fax Number:
301-232-3333
Provider Enumeration Date:
09/28/2022

Additional Information

Authorized Official

Authorized Official Last Name:
AL-ATTAR
Authorized Official First Name:
ALI
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING DIRECTOR
Authorized Official Telephone Number:
703-888-2034

Provider Taxonomy Codes

  • Taxonomy code: 2086S0122X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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