Aesthetic Plastic Surgery of Delaware, P.a.
Organization Active NPI Plastic Surgery Physician · Wilmington, DE
NPI 1760633861 · NPPES record last updated Oct 30, 2008
Key facts
- NPI
- 1760633861
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Plastic Surgery Physician 208200000X
- License
- C1000536 (DE)
- Legal business name
- AESTHETIC PLASTIC SURGERY OF DELAWARE, P.A.
- Practice address
- 1600 Pennsylvania Ave
Wilmington, DE 19806-4047 - Phone
- (302) 656-0214
- NPI assigned
- Oct 7, 2008
- Organization subpart
- No
Authorized official
- Name
- Ms. Dawn Micun
- Title
- Administrator
- Phone
- (302) 656-0214
Practitioners 1
-
Ian Michael Lonergan, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DE
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081030000516 | DE | Part B Supplier - Clinic/Group Practice | 0648339002 |
Receives reassigned benefits from 1 practitioner Practice locations: Wilmington, DE; Newark, DE |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician |
208200000X | C1000536 | DE | Yes |
Addresses
Primary practice location
1600 Pennsylvania Ave
Wilmington, DE 19806-4047
Mailing address
1600 Pennsylvania Ave
Wilmington, DE 19806-4047
Phone (302) 656-0214
NPI Registry JSON
{
"created_epoch": "1223337600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1225324800000",
"number": "1760633861",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 PENNSYLVANIA AVE",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198064047",
"telephone_number": "302-656-0214"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 PENNSYLVANIA AVE",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198064047",
"telephone_number": "302-656-0214"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AESTHETIC PLASTIC SURGERY OF DELAWARE, P.A.",
"organizational_subpart": "NO",
"enumeration_date": "2008-10-07",
"last_updated": "2008-10-30",
"status": "A",
"authorized_official_last_name": "MICUN",
"authorized_official_first_name": "DAWN",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "302-656-0214",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Plastic Surgery",
"state": "DE",
"license": "C1000536",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, DE
- Advanced Surgical Associates
- Advanced Treatment Options, LLC
- Nalini Mohan Advani
- Advocare , LLC
- Aesthetic and Special Care Associates,PA
- Affect Provider Group P.S.C.
- Affinity Comfort Counseling, LLC
- Affinity Health, L.L.C.
- Affinity Women'S Health LLC
- Affordable Home Care LLC
All providers in Wilmington, DE · Plastic Surgery Physician in Delaware
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.