Provider Demographics
NPI:1366759938
Name:BALTIMORE-WASHINGTON FACIAL PLASTIC SURGERY, LLC
Entity type:Organization
Organization Name:BALTIMORE-WASHINGTON FACIAL PLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:T
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-917-3223
Mailing Address - Street 1:4785 DORSEY HALL DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7728
Mailing Address - Country:US
Mailing Address - Phone:877-917-3223
Mailing Address - Fax:443-219-0758
Practice Address - Street 1:4785 DORSEY HALL DR
Practice Address - Street 2:SUITE 111
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7728
Practice Address - Country:US
Practice Address - Phone:877-917-3223
Practice Address - Fax:443-219-0758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2012-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061873207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty