Basic Information
| Provider Information | |||||||||
| NPI: | 1235195389 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILMINGTON PLASTIC SURGERY SPECIALISTS, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2305 CANTERWOOD DR | ||||||||
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| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284017300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103430119 | ||||||||
| FaxNumber: | 9103438983 | ||||||||
| Practice Location | |||||||||
| Address1: | 2305 CANTERWOOD DR | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284017300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103430119 | ||||||||
| FaxNumber: | 9103438983 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CUTRELL | ||||||||
| AuthorizedOfficialFirstName: | TERRI | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9106671120 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0122X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
No ID Information.