Provider Demographics
NPI:1124063318
Name:PLASTIC & RECONSTRUCTIVE SURGERY ASSOC LTD
Entity type:Organization
Organization Name:PLASTIC & RECONSTRUCTIVE SURGERY ASSOC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BARRETT
Authorized Official - Last Name:NOONE
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:610-304-7747
Mailing Address - Street 1:515 WALDRON PARK DR
Mailing Address - Street 2:
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-1929
Mailing Address - Country:US
Mailing Address - Phone:610-304-7747
Mailing Address - Fax:610-527-3568
Practice Address - Street 1:515 WALDRON PARK DR
Practice Address - Street 2:
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-1929
Practice Address - Country:US
Practice Address - Phone:610-304-7747
Practice Address - Fax:610-527-3568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029517-L2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB32874Medicare UPIN
PA017222FCVMedicare ID - Type Unspecified