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General NPI Number Information
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NPI Number | 1770877987
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Entity Type | Organization
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Legal Business Name | CUTTING EDGE DERMATOLOGY PLLC
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Dates
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Enumeration Date | 06/06/2011
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Last Update Date | 11/27/2025
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Provider Practice Location Address
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Address Line | 143 WOODLAND DR SW
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City | WISE
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State | VA
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Zip | 24293-4623
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Country | US
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Telephone | 276-365-8071
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Fax | 276-220-1529
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Provider Business Mailing Address
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Address Line | 5542 BURWELL RD
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City | WISE
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State | VA
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Zip | 24293-5929
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Country | US
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Telephone | 276-365-8071
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Fax | 276-221-1529
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. AUTUMN MARIE STARNES
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Credential | DO
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Telephone | 276-365-8071
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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 | S355332-0
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License Number State | VA
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