Provider Demographics
NPI:1396973053
Name:THE SKINSTITUTE
Entity type:Organization
Organization Name:THE SKINSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SMEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-246-2891
Mailing Address - Street 1:19465 DEERFIELD AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-1703
Mailing Address - Country:US
Mailing Address - Phone:703-914-3603
Mailing Address - Fax:
Practice Address - Street 1:19465 DEERFIELD AVE STE 201
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-1703
Practice Address - Country:US
Practice Address - Phone:703-914-3603
Practice Address - Fax:703-914-3604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235906207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH50422Medicare UPIN
1396973053Medicare NSC