Active NPI
Skin PC
- Dermatology Physician
- Reston, VA
National Provider Identifier
1821118613
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- Legal business name
- SKIN PC
- Practice address
- 1800 Town Center Dr Ste 212
Reston, VA 20190-3238 - Phone
- (703) 766-2220
- Fax
- (571) 323-1486
- NPI assigned
- Mar 29, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Colleen Rock
- Title
- Billing Credentialing
- Phone
- (703) 766-2220
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | Primary |
Addresses
Primary practice location
1800 Town Center Dr Ste 212
Reston, VA 20190-3238
Mailing address
1800 Town Center Dr Ste 212
Reston, VA 20190-3238
Phone (703) 766-2220
Other names 1
- Reston Dermatology Cosmetic Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
Enrollment records 1
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 49D2093822 | Reston Dermatology & Cosmetic Center | Certificate of waiver | Aug 20, 2027 |
National Provider Directory
National Provider DirectoryLocations
1830 Town Center Dr
Ste 310
Reston, VA 20190
Phone (703) 766-2220
Practitioners & affiliated clinicians
Practitioners 5
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175126400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1695513600000",
"number": "1821118613",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 TOWN CENTER DR STE 212",
"city": "RESTON",
"state": "VA",
"postal_code": "201903238",
"telephone_number": "703-766-2220",
"fax_number": "571-323-1486"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 TOWN CENTER DR STE 212",
"city": "RESTON",
"state": "VA",
"postal_code": "201903238",
"telephone_number": "703-766-2220",
"fax_number": "571-323-1486"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SKIN PC",
"organizational_subpart": "NO",
"enumeration_date": "2007-03-29",
"last_updated": "2023-09-24",
"certification_date": "2022-10-10",
"status": "A",
"authorized_official_last_name": "ROCK",
"authorized_official_first_name": "COLLEEN",
"authorized_official_title_or_position": "BILLING CREDENTIALING",
"authorized_official_telephone_number": "703-766-2220"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dermatology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Reston Dermatology Cosmetic Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Reston, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.