=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497146070
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAVOLA AESTHETIC DERMATOLOGY CENTER PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2015
-----------------------------------------------------
Last Update Date | 02/18/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 66 PARKWAY LANE SUITE 101
-----------------------------------------------------
City | FISHERSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-451-2833
-----------------------------------------------------
Fax | 540-451-2835
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 66 PARKWAY LANE SUITE 101
-----------------------------------------------------
City | FISHERSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-451-2833
-----------------------------------------------------
Fax | 540-451-2835
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KRISTEN SAVOLA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 434-249-9855
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------