Provider Demographics
NPI:1548760770
Name:COMPLEXIONS MEDICAL AESTHETICS
Entity Type:Organization
Organization Name:COMPLEXIONS MEDICAL AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:240-745-6585
Mailing Address - Street 1:8120 FENTON ST STE 202L
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4753
Mailing Address - Country:US
Mailing Address - Phone:202-681-4649
Mailing Address - Fax:
Practice Address - Street 1:4905 DEL RAY AVE STE 301
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2558
Practice Address - Country:US
Practice Address - Phone:240-745-6585
Practice Address - Fax:240-745-6585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center