Basic Information
| Provider Information | |||||||||
| NPI: | 1952496846 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COSMETIC SURGI CENTER OF MARYLAND | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8322 BELLONA AVENUE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102960414 | ||||||||
| FaxNumber: | 4102960412 | ||||||||
| Practice Location | |||||||||
| Address1: | 8322 BELLONA AVENUE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102960414 | ||||||||
| FaxNumber: | 4102960412 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 01/02/2008 | ||||||||
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| AuthorizedOfficialLastName: | COHEN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PLASTIC SURGEON | ||||||||
| AuthorizedOfficialTelephone: | 4102960414 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | MD | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.