1427088731 NPI number — LE VISAGE ENT & FACIAL PLASTIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427088731 NPI number — LE VISAGE ENT & FACIAL PLASTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LE VISAGE ENT & FACIAL PLASTIC
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:
Provider Other Organization Name Type Code:
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:
1427088731
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6410 ROCKLEDGE DR
Provider Second Line Business Mailing Address:
#650
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20817-1809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-897-5858
Provider Business Mailing Address Fax Number:
301-897-5860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6410 ROCKLEDGE DR
Provider Second Line Business Practice Location Address:
#650
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20817-1809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-897-5858
Provider Business Practice Location Address Fax Number:
301-897-5860
Provider Enumeration Date:
07/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
DUANE
Authorized Official Middle Name:
JON
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
301-897-5858

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  D00040031 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207YX0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com