MEDICARE: THE SKINSTITUTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	0101235906	VA

General Provider Information

NPI Number	:	1396973053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SKINSTITUTE

Provider Business Mailing Address
First Line	:	19465 DEERFIELD AVE STE 201
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20176-1703
Country	:	US
Telephone Number	:	703-914-3603
Fax Number	:

Provider Business Practice Location Address
First Line	:	19465 DEERFIELD AVE STE 201
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20176-1703
Country	:	US
Telephone Number	:	703-914-3603
Fax Number	:	703-914-3604

Authorized Official
Title or Position	:	OWNER
Name	:	SMEENA KHAN
Credential	:	MD
Telephone Number	:	571-246-2891

Provider Enumeration Date	:	07/01/2009
Last Update Date	:	03/20/2023

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Directions to “THE SKINSTITUTE ” Practice Location

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