Provider Demographics
NPI:1558804625
Name:SKINDC PLLC
Entity Type:Organization
Organization Name:SKINDC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-966-7127
Mailing Address - Street 1:1525 WILSON BLVD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-2411
Mailing Address - Country:US
Mailing Address - Phone:703-966-7127
Mailing Address - Fax:844-357-7049
Practice Address - Street 1:1525 WILSON BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-2411
Practice Address - Country:US
Practice Address - Phone:703-966-7127
Practice Address - Fax:844-357-7049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty