NPIMap

Organization Active NPI

Aesthetic & Reconstructive Plastic Surgery,PLLC

  • Specialist
  • Raleigh, NC
National Provider Identifier
1659324648
Registry record updated Oct 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
31126 Issued in NC
Legal business name
AESTHETIC & RECONSTRUCTIVE PLASTIC SURGERY,PLLC
Practice address
2304 Wesvill CT
# 360
Raleigh, NC 27607-2973
Phone
(919) 785-1220
Fax
(919) 785-1205
NPI assigned
May 18, 2006
Last updated
Oct 20, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2010

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

Authorized official

Name
Ms. Maryann M Davis
Title
Practice Manager
Phone
(919) 785-1220

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 31126 NC Primary

Addresses

Primary practice location

2304 Wesvill CT
# 360
Raleigh, NC 27607-2973

Mailing address

2304 Wesvill CT
# 360
Raleigh, NC 27607-2973
Phone (919) 785-1220

Other identifiers 1

IdentifierTypeStateIssuer
8927438MedicaidNC

National Provider Directory

National Provider Directory

Locations

2304 Wesvill Ct
Ste 360
Raleigh, NC 27607
Phone (919) 785-1220

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287532800000",
    "number": "1659324648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2304 WESVILL CT",
            "address_2": "# 360",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276072973",
            "telephone_number": "919-785-1220",
            "fax_number": "919-785-1205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2304 WESVILL CT",
            "address_2": "# 360",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276072973",
            "telephone_number": "919-785-1220",
            "fax_number": "919-785-1205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AESTHETIC & RECONSTRUCTIVE PLASTIC SURGERY,PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2010-10-20",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "MARYANN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "919-785-1220",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NC",
            "license": "31126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8927438",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2010; 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.