Provider Demographics
NPI:1174186100
Name:LUXE DERMATOLOGY AND AESTHETIC CENTER, PLLC
Entity Type:Organization
Organization Name:LUXE DERMATOLOGY AND AESTHETIC CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-274-4199
Mailing Address - Street 1:8200 GREENSBORO DR STE 801
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4925
Mailing Address - Country:US
Mailing Address - Phone:703-942-9787
Mailing Address - Fax:703-563-3824
Practice Address - Street 1:8200 GREENSBORO DR STE 801
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4925
Practice Address - Country:US
Practice Address - Phone:703-942-9787
Practice Address - Fax:703-563-3824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty