Organization
VISAGE DERMATOLOGY AND AESTHETIC CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHARLEEN ST. SURIN-LORD M.D. (MEDICAL DIRECTOR)
(240) 223-3533
Entity
Organization
Contact information
Practice address
1400 MERCANTILE LN, SUITE 110, LARGO, MD 20774-5341
(240) 223-3533
(240) 465-4800
Mailing address
PO BOX 7224, LARGO, MD 20792-7224
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
D0065513
MD
Other
Enumeration date
11/19/2012
Last updated
12/20/2012
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