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Organization
JEV PLASTIC SURGERY AND MEDICAL AESTHETICS, LLC.
Active
Organization
JEV PLASTIC SURGERY AND MEDICAL AESTHETICS, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARRIE A. HOUSSOCK M.D. (PRESIDENT)
(410) 484-8860
Entity
Organization
Contact information
Practice address
4 PARK CENTER COURT, SUITE 100, OWINGS MILLS, MD 21117
(410) 484-8860
(410) 484-2566
Mailing address
4 PARK CENTER COURT, SUITE 100, OWINGS MILLS, MD 21117
(410) 484-8860
(410) 484-2566
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21C-6000123
—
MD
Enumeration date
01/21/2020
Last updated
01/21/2020
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