Healthcare Provider Details

I. General information

NPI: 1578129599
Provider Name (Legal Business Name): METRO MOHS SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 BACKLICK RD STE 120
SPRINGFIELD VA
22151-3940
US

IV. Provider business mailing address

5501 BACKLICK RD STE 110&120
SPRINGFIELD VA
22151-3933
US

V. Phone/Fax

Practice location:
  • Phone: 301-966-7744
  • Fax:
Mailing address:
  • Phone: 703-705-7505
  • Fax: 866-990-3880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY SELLIN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 703-705-7505