Organization
AESTHETIC FACIAL PLASTIC SURGERY CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERALDINE H MALLOY (CREDENTIALING SPECIALIST)
(570) 386-2366
Entity
Organization
Contact information
Practice address
101 CHESLEY DR, GEORGTOWN BUILDING, MEDIA, PA 19063-1761
(610) 565-6230
(570) 386-3130
Mailing address
101 CHESLEY DR, GEORGTOWN BUILDING, MEDIA, PA 19063-1761
Taxonomy
Speciality
Code
Description
License number
State
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
Primary
MD068106L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD068106L
STATE LICENSE
PA
Enumeration date
09/21/2007
Last updated
09/21/2007
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