Provider Demographics
NPI:1366549537
Name:COSMETIC SURGICAL CENTER PA
Entity type:Organization
Organization Name:COSMETIC SURGICAL CENTER PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VASDEV
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-392-3511
Mailing Address - Street 1:7777 FOREST LANE
Mailing Address - Street 2:SUITE # C612
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2520
Mailing Address - Country:US
Mailing Address - Phone:972-392-3511
Mailing Address - Fax:972-788-0907
Practice Address - Street 1:7777 FOREST LANE
Practice Address - Street 2:SUITE # C612
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2520
Practice Address - Country:US
Practice Address - Phone:972-392-3511
Practice Address - Fax:972-788-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C20774Medicare UPIN