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Individual

COREY DEWITT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
19465 DEERFIELD AVENUE, SUITE 401, LEESBURG, VA 20176-1707
(703) 723-5700
(703) 723-5778
Mailing address
224-D CORNWALL STREET, NW, SUITE 403, LEESBURG, VA 20176-2704
(703) 737-6010
(703) 433-8643

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
MD23389
ME
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
0101275415
VA
207ND0101X
MOHS-Micrographic Surgery Physician
D91604
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1417342890
VA
05
30017465030001
VA
Enumeration date
04/01/2015
Last updated
11/29/2023
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