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General NPI Number Information
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NPI Number | 1609759752
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Entity Type | Organization
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Legal Business Name | SKIN DEEP CONCIERGE MEDICINE LLC
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Dates
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Enumeration Date | 07/28/2025
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 225 OAK SPRINGS DR STE 102
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City | WARRENTON
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State | VA
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Zip | 20186-2186
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Country | US
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Telephone | 540-935-4449
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Fax | 540-347-4444
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Provider Business Mailing Address
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Address Line | 225 OAK SPRINGS DR STE 102
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City | WARRENTON
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State | VA
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Zip | 20186-2186
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Country | US
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Telephone | 540-935-4449
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Fax | 540-347-4444
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Authorized Official
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Title or Position | OWNER
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Name | HEATHER RENEE CALLAHAN
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Credential | PA
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Telephone | 703-338-2317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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