Provider Demographics
NPI:1609759752
Name:SKIN DEEP CONCIERGE MEDICINE LLC
Entity type:Organization
Organization Name:SKIN DEEP CONCIERGE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:703-338-2317
Mailing Address - Street 1:225 OAK SPRINGS DR STE 102
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2186
Mailing Address - Country:US
Mailing Address - Phone:540-935-4449
Mailing Address - Fax:540-347-4444
Practice Address - Street 1:225 OAK SPRINGS DR STE 102
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2186
Practice Address - Country:US
Practice Address - Phone:540-935-4449
Practice Address - Fax:540-347-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty