MEDICARE: RENEWAL DERMATOLOGY & MEDSPA, P.C.

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	207ND0101X	MOHS-Micrographic Surgery Physician
2	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1619232469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEWAL DERMATOLOGY & MEDSPA, P.C.

Provider Business Mailing Address
First Line	:	7512 GARDNER PARK DR
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3414
Country	:	US
Telephone Number	:	703-753-9860
Fax Number	:	703-753-9863

Provider Business Practice Location Address
First Line	:	7512 GARDNER PARK DR
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3414
Country	:	US
Telephone Number	:	703-753-9860
Fax Number	:	703-753-9863

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KURT L MAGGIO
Credential	:	M.D.
Telephone Number	:	703-753-9860

Provider Enumeration Date	:	07/09/2012
Last Update Date	:	12/09/2025

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