NPI Code Detail JSON Logo

1609759752 NPI number — SKIN DEEP CONCIERGE MEDICINE LLC

NPI Number: 1609759752
Health Care Provider/Practitioner: SKIN DEEP CONCIERGE MEDICINE LLC

Information about “1609759752” NPI (SKIN DEEP CONCIERGE MEDICINE LLC) exists in 1609759752 in HTML format HTML  |  1609759752 in plain Text format TXT  |  1609759752 in PDF (Portable Document Format) PDF  |  1609759752 in an XML format XML  formats.

NPI Number : 1609759752 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1609759752",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SKIN DEEP CONCIERGE MEDICINE LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "225 OAK SPRINGS DR STE 102",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WARRENTON",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "20186-2186",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "540-935-4449",
    "MailingAddressFaxNumber": "540-347-4444",
    "FirstLinePracticeLocationAddress": "225 OAK SPRINGS DR STE 102",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WARRENTON",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "20186-2186",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "540-935-4449",
    "PracticeLocationAddressFaxNumber": "540-347-4444",
    "EnumerationDate": "07/28/2025",
    "LastUpdateDate": "07/28/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "CALLAHAN",
    "AuthorizedOfficialFirstName": "HEATHER",
    "AuthorizedOfficialMiddleName": "RENEE",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PA",
    "AuthorizedOfficialTelephoneNumber": "703-338-2317",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207N00000X",
        "TaxonomyName": "Dermatology Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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