Provider Demographics
NPI:1477337640
Name:AESTHETIC DERMATOLOGY AND MOHS SURGERY, LLC
Entity Type:Organization
Organization Name:AESTHETIC DERMATOLOGY AND MOHS SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JON
Authorized Official - Last Name:TINKLEPAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-529-5600
Mailing Address - Street 1:8522 ARDFOUR LN
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-4506
Mailing Address - Country:US
Mailing Address - Phone:703-801-0036
Mailing Address - Fax:
Practice Address - Street 1:2826 OLD LEE HWY STE 150
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4323
Practice Address - Country:US
Practice Address - Phone:571-529-5600
Practice Address - Fax:571-529-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty