MEDICARE: COMPLEXIONS MEDICAL AESTHETICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1548760770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLEXIONS MEDICAL AESTHETICS

Provider Business Mailing Address
First Line	:	8120 FENTON ST STE 202L
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4753
Country	:	US
Telephone Number	:	202-681-4649
Fax Number	:

Provider Business Practice Location Address
First Line	:	4905 DEL RAY AVE STE 301
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-2558
Country	:	US
Telephone Number	:	240-745-6585
Fax Number	:	240-745-6585

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	STEPHANIE KNOX
Credential	:	NP-C
Telephone Number	:	240-745-6585

Provider Enumeration Date	:	02/14/2018
Last Update Date	:	02/14/2018

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