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Provider Information for 1578763199

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COSMETIC SURGERY FACILITY LLC

Other Name:   Doing Business As: COSMETICSURG.NET
Organization Subpart: NO

Organization NPI: 1578763199

Calendar   Last Updated:  2014-04-15
  Certification Date: 

Details

Name Value
NPI 1578763199
Enumeration Date 2007-07-22
NPI Type 2- Organization
Status Active
Authorized Official Information Name: DR. RICARDO L RODRIGUEZ M.D.
Title: MEDICAL DIRECTOR
Phone: 410-494-8100
Mailing Address 1300 BELLONA AVE SUITE C
LUTHERVILLE TIMONIUM, MD 21093-5465
United States

Phone: 410-494-8100 | Fax: 410-494-0815
View Map External Link
Primary Practice Address 1300 BELLONA AVE SUITE C
LUTHERVILLE TIMONIUM, MD 21093-5465
United States

Phone: 410-494-8100 | Fax: 410-494-0815
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 261QA1903X - Clinic/Center Ambulatory Surgical MD A1462
No 261QA1903X - Clinic/Center Ambulatory Surgical
No 193400000X SINGLE SPECIALTY GROUP
208200000X - Plastic Surgery		 MD D41395