Provider Demographics
NPI:1770877987
Name:CUTTING EDGE DERMATOLOGY PLLC
Entity type:Organization
Organization Name:CUTTING EDGE DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:STARNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-220-1165
Mailing Address - Street 1:5542 BURWELL ROAD
Mailing Address - Street 2:
Mailing Address - City:WISE
Mailing Address - State:VA
Mailing Address - Zip Code:24293
Mailing Address - Country:US
Mailing Address - Phone:276-365-8071
Mailing Address - Fax:949-862-3723
Practice Address - Street 1:143 WOODLAND DR SW
Practice Address - Street 2:
Practice Address - City:WISE
Practice Address - State:VA
Practice Address - Zip Code:24293-4623
Practice Address - Country:US
Practice Address - Phone:276-365-8071
Practice Address - Fax:949-862-3723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAS355332-0207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty