Provider Demographics
NPI:1154806271
Name:THE COSMETIC CONCIERGE, PLLC
Entity type:Organization
Organization Name:THE COSMETIC CONCIERGE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-938-0459
Mailing Address - Street 1:325 ARLINGTON AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4574
Mailing Address - Country:US
Mailing Address - Phone:980-938-0459
Mailing Address - Fax:980-938-0444
Practice Address - Street 1:325 ARLINGTON AVE UNIT B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4574
Practice Address - Country:US
Practice Address - Phone:980-938-0459
Practice Address - Fax:980-938-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty