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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