The Plastic & Reconstructive Surgery Institute, LLC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

D0058474 Issued in MD

Legal business name

THE PLASTIC & RECONSTRUCTIVE SURGERY INSTITUTE, LLC

Practice address

5601 Loch Raven Blvd
Smyth Professional BLDG., Suite 200
Baltimore, MD 21239-2905

Phone

(443) 687-9990

Fax

(443) 740-9278

NPI assigned

Apr 3, 2012

Organization subpart

No

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

Authorized official

Name

Dr. David Zachary Martin, MD

Title

Owner/Physician

Phone

(443) 687-9990

Specialties & licenses 1

Addresses

Other identifiers 10

Locations

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

{
    "created_epoch": "1333411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411689600000",
    "number": "1760748800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5601 LOCH RAVEN BLVD",
            "address_2": "SMYTH PROFESSIONAL BLDG., SUITE 200",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212392905",
            "telephone_number": "443-687-9990",
            "fax_number": "443-740-9278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5601 LOCH RAVEN BLVD",
            "address_2": "SMYTH PROFESSIONAL BLDG., SUITE 200",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212392905",
            "telephone_number": "443-687-9990",
            "fax_number": "443-740-9278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PLASTIC & RECONSTRUCTIVE SURGERY INSTITUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-03",
        "last_updated": "2014-09-26",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ZACHARY",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "443-687-9990",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "MD",
            "license": "D0058474",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN HOPKINS - EHP, PRIORITY PARTNERS, US FAMILY",
            "identifier": "107100",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BRAVO",
            "identifier": "1972585206",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "1760748800",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARYLAND PHYSICIANS CARE",
            "identifier": "1760748800",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDSTAR FAMILY CHOICE",
            "identifier": "1760748800",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE ALL PRODUCTS EXCEPT AMERICHOICE",
            "identifier": "1760748800",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BLUECROSS BLUESHIELD ALL PRODUCTS",
            "identifier": "AB87",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1188979",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DS9899",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA ALL PRODUCTS",
            "identifier": "1760748800",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Plastic Surgery Physician in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Plastic Surgery Physician in Maryland

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