Basic Information
| Provider Information | |||||||||
| NPI: | 1174033195 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REJUVE INSTITUTE REJUVE COSMETIC SURGERY AND MEDSPA | ||||||||
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| OtherOrganizationName: | REJUVE PLASTIC SURGERY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 CHAIN BRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | MC LEAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221013935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038324000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1300 CHAIN BRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | MC LEAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221013935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038324000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2017 | ||||||||
| LastUpdateDate: | 01/24/2018 | ||||||||
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| AuthorizedOfficialLastName: | BHATT | ||||||||
| AuthorizedOfficialFirstName: | KIRIT | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3477449188 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0122X | 0101254386 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
No ID Information.