Healthcare Provider Details

I. General information

NPI: 1861820904
Provider Name (Legal Business Name): MED SPA OF VIRGINIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 SUNSET LN SUITE 302
CULPEPER VA
22701-3979
US

IV. Provider business mailing address

541 SUNSET LN SUITE 302
CULPEPER VA
22701-3979
US

V. Phone/Fax

Practice location:
  • Phone: 540-825-8550
  • Fax: 540-825-8575
Mailing address:
  • Phone: 540-825-8550
  • Fax: 540-825-8575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number0101033835
License Number StateVA

VIII. Authorized Official

Name: KARL M. BEIER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 540-825-8550