NPIMap

Organization Active NPI

Sculpsit Surgery Inc

  • Specialist
  • Vienna, VA
National Provider Identifier
1184906034
Registry record updated Sep 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
010123873 Issued in VA
Legal business name
SCULPSIT SURGERY INC
Practice address
415 Church St NE
Suite 102
Vienna, VA 22180-4742
Phone
(703) 242-6363
Fax
(703) 242-6368
NPI assigned
Sep 16, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2011

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

Authorized official

Name
Mr. Sean F Wolfort, M.D.
Title
Owner
Phone
(703) 242-6363

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 010123873 VA Primary

Addresses

Primary practice location

415 Church St NE
Suite 102
Vienna, VA 22180-4742

Mailing address

415 Church St NE
Suite 102
Vienna, VA 22180-4742
Phone (703) 242-6363

National Provider Directory

National Provider Directory

Locations

415 Church St NE
Ste 102
Vienna, VA 22180
Phone (703) 242-6363

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1316131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316131200000",
    "number": "1184906034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 CHURCH ST NE",
            "address_2": "SUITE 102",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221804742",
            "telephone_number": "703-242-6363",
            "fax_number": "703-242-6368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 CHURCH ST NE",
            "address_2": "SUITE 102",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221804742",
            "telephone_number": "703-242-6363",
            "fax_number": "703-242-6368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCULPSIT SURGERY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-16",
        "last_updated": "2011-09-16",
        "status": "A",
        "authorized_official_last_name": "WOLFORT",
        "authorized_official_first_name": "SEAN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-242-6363",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "VA",
            "license": "010123873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vienna, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2011; 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.