Healthcare Provider Details

I. General information

NPI: 1770877987
Provider Name (Legal Business Name): CUTTING EDGE DERMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 11/27/2025
Certification Date: 11/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 WOODLAND DR SW
WISE VA
24293-4623
US

IV. Provider business mailing address

5542 BURWELL RD
WISE VA
24293-5929
US

V. Phone/Fax

Practice location:
  • Phone: 276-365-8071
  • Fax: 276-220-1529
Mailing address:
  • Phone: 276-365-8071
  • Fax: 276-221-1529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberS355332-0
License Number StateVA

VIII. Authorized Official

Name: DR. AUTUMN MARIE STARNES
Title or Position: PHYSICIAN OWNER
Credential: DO
Phone: 276-365-8071