Provider Demographics
NPI:1427142223
Name:VALLEY SQUARE PLASTIC SURGERY CENTER
Entity type:Organization
Organization Name:VALLEY SQUARE PLASTIC SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:T
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-493-8808
Mailing Address - Street 1:1133 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-2489
Mailing Address - Country:US
Mailing Address - Phone:215-491-2000
Mailing Address - Fax:215-491-7000
Practice Address - Street 1:1133 MAIN ST.
Practice Address - Street 2:
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976
Practice Address - Country:US
Practice Address - Phone:215-491-2000
Practice Address - Fax:215-491-7000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA83802297208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC29102Medicare UPIN