# PENINSULA PLASTIC SURGERY CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689731986
- **Authorized official:** DR. JOHN M. PITMAN III M.D. (PHYSICIAN)
- **Authorized official phone:** (757) 229-5200

## Contact information

- **Practice address:** 324 MONTICELLO AVE, WILLIAMSBURG, VA 23185-2834
- **Practice address phone:** (757) 229-5200
- **Practice address fax:** (757) 229-2692
- **Mailing address:** 324 MONTICELLO AVE, WILLIAMSBURG, VA 23185-2834
- **Mailing address phone:** (757) 229-5200
- **Mailing address fax:** (757) 229-2692

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | 0101052484 | VA | — |
| 208200000X | Plastic Surgery Physician | — | NULL | — |
| 208200000X | Plastic Surgery Physician | — | — | — |
| 2082S0105X | Surgery of the Hand (Plastic Surgery) Physician | — | NULL | — |
| 2082S0105X | Surgery of the Hand (Plastic Surgery) Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/03/2007
- **Last updated:** 12/11/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 007601328 | — | VA |
| 01 | — | 121242 | SOUTHERN HEALTH | VA |
| 01 | — | 140457 | ANTHEM | VA |
| 01 | — | 213427 | CIGNA | VA |
| 01 | — | 432612 | UNITED HEALTHCARE | VA |
| 01 | — | 5209080 | AETNA | VA |
| 01 | — | 54536 | SENTARA OPTIMA | VA |
| 01 | — | 620043172 | RAILROAD MEDICARE | VA |