Organization
RENASCANCE DERMATOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DWANA RASHAD SHABAZZ M.D. (OWNER)
(703) 865-6783
Entity
Organization
Contact information
Practice address
3620 JOSEPH SIEWICK DR, SUITE 303, FAIRFAX, VA 22033-1756
(703) 865-6783
(703) 865-6784
Mailing address
3620 JOSEPH SIEWICK DR, SUITE 303, FAIRFAX, VA 22033-1756
(703) 865-6783
(703) 865-6784
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
0101240235
VA
Other
Enumeration date
05/01/2013
Last updated
05/01/2013
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