Provider Demographics
NPI:1881925311
Name:RECONSTRUCTIVE PLASTIC SURGERY CONSULTANTS, LLC
Entity type:Organization
Organization Name:RECONSTRUCTIVE PLASTIC SURGERY CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRALIAKBARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-645-0077
Mailing Address - Street 1:3289 WOODBURN RD
Mailing Address - Street 2:SUITE 245
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003
Mailing Address - Country:US
Mailing Address - Phone:703-645-0077
Mailing Address - Fax:
Practice Address - Street 1:3289 WOODBURN RD
Practice Address - Street 2:SUITE 245
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-6800
Practice Address - Country:US
Practice Address - Phone:703-645-0077
Practice Address - Fax:703-645-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101243338208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA134357ZA6WMedicare UPIN