MCLEAN DERMATOLOGY AND SKINCARE CENTER (NPI# 1255645776) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255645776 |
| Entity Type | Organization |
| Organization Name | MCLEAN DERMATOLOGY AND SKINCARE CENTER |
| Practice Address |
6849 Old Dominion Dr Suite 340 Mc Lean VA 22101-3724 |
| Mailing Address |
Po Box 9143 Mc Lean VA 22102-0143 |
| Practice Telephone | 7033565111 |
| Practice Fax Number | 7033880873 |
| Mailing Telephone | 7033565111 |
| Mailing Fax Number | 7033880873 |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2013-05-17 |
| Authorized Official Name | DR. LILY TALAKOUB (OWNER) |
| Authorized Official Telephone | 7033565111 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
01012445533 | VA | Ambulatory Health Care Facilities |
| Street Address |
6849 OLD DOMINION DR SUITE 340 |
| City | MC LEAN |
| State | VA |
| Zip Code | 22101-3724 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972911931 | Patricia Odom | Physical Therapist | 6849 Old Dominion Dr, Suite 330, Mc Lean, VA 22101-3724 | 2014-07-23 |
| 1275788218 | Elizabeth Edwards | Physical Therapist | 6849 Old Dominion Dr, Ste 221, Mc Lean, VA 22101-3724 | 2008-11-18 |
| 1801069810 | Nguyen Vision Inc | Optometrist | 6849 Old Dominion Dr, Suite 300, Mc Lean, VA 22101-3724 | 2008-04-10 |
| 1942488549 | Wendy Carin Garson | Optometrist | 6849 Old Dominion Dr, #300, Mc Lean, VA 22101 | 2008-02-06 |
| 1528257177 | Aubry Ridpath | Physical Therapist | 6849 Old Dominion Dr, Suite 221, Mc Lean, VA 22101-3724 | 2007-10-19 |
| 1528287406 | Karin Conley Steele | Physical Therapist | 6849 Old Dominion Dr, Suite 221, Mc Lean, VA 22101-3724 | 2007-04-25 |
| 1801929773 | Lily Talakoub | Dermatology | 6849 Old Dominion Dr, Suite 204, Mc Lean, VA 22101-3724 | 2007-03-13 |
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| 1326691759 | Vansay Vorrasane | Physical Therapist | 1735 Kirby Road, Mclean, VA 22101 | 2019-07-24 |
| 1912464025 | Veronica Martinez | Occupational Therapist | 1735 Kirby Rd., Mclean, VA 22101 | 2019-02-25 |
| 1114409547 | Katia Julio Salomao | Behavior Technician | 1651 Old Meadow Rd Suite 600, Mclean, VA 22101 | 2018-09-01 |
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| 1104347962 | Louise Parry | Social Worker | 1491 Chain Bridge Road #300, Weaver and Associates, Mclean, VA 22101 | 2017-07-03 |
| 1366979361 | Anita Kathleen Bryce | Social Worker | 1364 Beverly Road, #304, Mclean, VA 22101 | 2017-05-22 |
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| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
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| 1487944070 | Prince William Chiropractic Clinic | Clinic/Center | 2026 Opitz Blvd Ste B, Woodbridge, VA 22191-3332 | 2011-04-15 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.