Provider Demographics
NPI:1659896876
Name:BEAUTIFUL SKIN INSTITUTE, PLLC
Entity Type:Organization
Organization Name:BEAUTIFUL SKIN INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLEMENS
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-790-2500
Mailing Address - Street 1:171 ELDEN ST STE 3B
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4875
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:171 ELDEN ST STE 3B
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4875
Practice Address - Country:US
Practice Address - Phone:202-790-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101251160261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty