Organization
MONTICELLO PLASTIC AND RECONSTRUCTIVE SURGERY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN M SHOWALTER M.D. (PRESIDENT/CEO)
(434) 260-5130
Entity
Organization
Contact information
Practice address
1490 PANTOPS MOUNTAIN PL, SUITE 100, CHARLOTTESVILLE, VA 22911-4601
(434) 260-5130
(434) 995-5948
Mailing address
PO BOX 5508, VIRGINIA BEACH, VA 23471-0508
(757) 340-3489
(757) 340-4278
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
0101255390
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023429818
—
VA
Enumeration date
05/14/2014
Last updated
08/26/2014
Update your record
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