Provider Demographics
NPI:1366195257
Name:AMG PLASTIC SURGERY LLC
Entity type:Organization
Organization Name:AMG PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:M
Authorized Official - Last Name:GHAZNAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-239-3190
Mailing Address - Street 1:13454 SUNRISE VALLEY DR STE 130
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-3278
Mailing Address - Country:US
Mailing Address - Phone:703-239-3190
Mailing Address - Fax:
Practice Address - Street 1:13454 SUNRISE VALLEY DR STE 130
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-3278
Practice Address - Country:US
Practice Address - Phone:703-239-3190
Practice Address - Fax:571-621-7593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty