# AESTHETICS & BODY LAB

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356105241
- **Authorized official:** KEISHA BERNARD NP (OWNER)
- **Authorized official phone:** (240) 328-2015

## Contact information

- **Practice address:** 9650 SANTIAGO RD STE 7, COLUMBIA, MD 21045-3960
- **Practice address phone:** (301) 309-7307
- **Practice address fax:** (301) 238-8039
- **Mailing address:** 9650 SANTIAGO RD STE 7, COLUMBIA, MD 21045-3960
- **Mailing address phone:** (301) 309-7307
- **Mailing address fax:** (301) 238-8039

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/12/2024
- **Last updated:** 02/12/2024