Provider Demographics
NPI:1992964811
Name:GERMAIN PLASTIC SURGERY PLLC
Entity type:Organization
Organization Name:GERMAIN PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLASTIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:GERMAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-442-8040
Mailing Address - Street 1:1355 BEVERLY RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3651
Mailing Address - Country:US
Mailing Address - Phone:703-442-8040
Mailing Address - Fax:703-992-8354
Practice Address - Street 1:1355 BEVERLY RD
Practice Address - Street 2:SUITE 220
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3651
Practice Address - Country:US
Practice Address - Phone:703-442-8040
Practice Address - Fax:703-992-8354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238468208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty