1902010309 NPI number — RENAISSANCE PLASTIC SURGERY GROUP LLC

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 1902010309 NPI number — RENAISSANCE PLASTIC SURGERY GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RENAISSANCE PLASTIC SURGERY GROUP 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:
Provider Other Organization Name Type Code:
6
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:
1902010309
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 101836
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15237-0836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-232-8089
Provider Business Mailing Address Fax Number:
412-232-8340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1350 LOCUST ST
Provider Second Line Business Practice Location Address:
G103
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15219-4738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-232-8089
Provider Business Practice Location Address Fax Number:
412-232-8340
Provider Enumeration Date:
05/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STOFMAN
Authorized Official First Name:
GUY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
412-232-8089

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD034789E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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