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General NPI Number Information
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NPI Number | 1891509402
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Entity Type | Organization
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Legal Business Name | CLEAR DERMATOLOGY
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 22365 BRODERICK DR STE 115
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City | STERLING
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State | VA
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Zip | 20166-9362
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Country | US
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Telephone | 917-776-4742
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Fax |
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Provider Business Mailing Address
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Address Line | 22365 BRODERICK DR STE 115
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City | STERLING
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State | VA
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Zip | 20166-9362
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Country | US
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Telephone | 917-776-4742
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHANIE DANIEL
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Credential | MD
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Telephone | 917-776-4742
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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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