PENINSULA PLASTIC SURGERY CENTER NPI 1689731986

NPI Information

NPI: 1689731986
Provider Name: PENINSULA PLASTIC SURGERY CENTER
Classification: General Practice - 208D00000X
Entity Type: Organization

CLIA Number: 49D0959143

Address:
324 MONTICELLO AVE
WILLIAMSBURG, VA
ZIP 23185
Phone: (757) 229-5200
Get Directions

PENINSULA PLASTIC SURGERY CENTER is a general practice in Williamsburg, VA. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee PENINSULA PLASTIC SURGERY CENTER NPI is 1689731986. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

324 MONTICELLO AVE
WILLIAMSBURG, VA
ZIP 23185-834
Phone: (757) 229-5200
Fax: (757) 229-2692

The provider's authorized official is John M. Pitman .
The authorized official title is Physician and has the following contact phone number (757) 229-5200.

The CLIA number assigned to this NPI record is 49D0959143 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 1/3/2007 and was last updated on 12/11/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	174400000X	Specialist		0101052484	VIRGINIA	No
2	208200000X	Plastic Surgery				No
3	2082S0105X	Plastic Surgery	Surgery of the Hand			No
4	208D00000X	General Practice				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	007601328	MEDICAID	VIRGINIA
2	121242	OTHER	VIRGINIA	SOUTHERN HEALTH
3	140457	OTHER	VIRGINIA	ANTHEM
4	432612	OTHER	VIRGINIA	UNITED HEALTHCARE
5	54536	OTHER	VIRGINIA	SENTARA OPTIMA
6	5209080	OTHER	VIRGINIA	AETNA
7	620043172	OTHER	VIRGINIA	RAILROAD MEDICARE
8	213427	OTHER	VIRGINIA	CIGNA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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