Monticello Plastic and Reconstructive Surgery, PC

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

0101255390 Issued in VA

Legal business name

MONTICELLO PLASTIC AND RECONSTRUCTIVE SURGERY, PC

Practice address

1490 Pantops Mountain PL
Suite 100
Charlottesville, VA 22911-4601

Phone

(434) 260-5130

Fax

(434) 995-5948

NPI assigned

May 14, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brian M Showalter, M.D.

Title

President/Ceo

Phone

(434) 260-5130

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1400025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409011200000",
    "number": "1023429818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5508",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234710508",
            "telephone_number": "757-340-3489",
            "fax_number": "757-340-4278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1490 PANTOPS MOUNTAIN PL",
            "address_2": "SUITE 100",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229114601",
            "telephone_number": "434-260-5130",
            "fax_number": "434-995-5948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTICELLO PLASTIC AND RECONSTRUCTIVE SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-14",
        "last_updated": "2014-08-26",
        "status": "A",
        "authorized_official_last_name": "SHOWALTER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "434-260-5130",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "VA",
            "license": "0101255390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023429818",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Margaret Peery Monroe
• Roshni Montana, MD
• Matthew Thomas Montgomery, MD
• Richard M Montgomery, MD
• Monticello Community Surgery Center, LLC
• Gerald Montoya, DNP FNP
• David Tipton Moody, M.D.
• Addison Moon
• Ashley Virginia Moon, MD
• Dayoung Moon, PA-C

• Plastic and Reconstructive Surgery Physician in Charlottesville, VA
• Providers in Charlottesville, VA by specialty
• Plastic and Reconstructive Surgery Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.