Provider Demographics
NPI:1093344210
Name:VIRGINIA WOMENS CENTER FOR AESTHETICS
Entity Type:Organization
Organization Name:VIRGINIA WOMENS CENTER FOR AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:AYOUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-858-5399
Mailing Address - Street 1:19490 SANDRIDGE WAY STE 360
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3467
Mailing Address - Country:US
Mailing Address - Phone:703-858-5399
Mailing Address - Fax:703-858-5699
Practice Address - Street 1:19490 SANDRIDGE WAY STE 360
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3467
Practice Address - Country:US
Practice Address - Phone:703-858-5399
Practice Address - Fax:703-858-5699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1790836690OtherJACK PETE AYOUB
VA1942440953OtherVIRGINIA OBSTETRICS & GYNECOLOGY PC