Organization
PENINSULA PLASTIC SURGERY CENTER-ASC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN M. PITMAN III M.D. (PHYSICIAN)
(757) 229-5200
Entity
Organization
Contact information
Practice address
324 MONTICELLO AVE, WILLIAMSBURG, VA 23185-2834
(757) 229-5200
(757) 229-2692
Mailing address
324 MONTICELLO AVE, WILLIAMSBURG, VA 23185-2834
(757) 229-5200
(757) 229-2692
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0101052484
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
121242
SOUTHERN HEALTH
VA
01
—
213427
CIGNA
VA
01
—
289668
ANTHEM
VA
01
—
289669
ANTHEM
VA
01
—
432612
UNITED HEALTHCARE
VA
01
—
5209080
AETNA
VA
01
—
54536
SENTARA OPTIMA
VA
Enumeration date
01/03/2007
Last updated
04/20/2008
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