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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
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