Organization
SKIN AND LASER SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMIR BAJOGHLI MD (PRESIDENT)
(703) 492-4140
Entity
Organization
Contact information
Practice address
8130 BOONE BLVD, SUITE 340, VIENNA, VA 22182-2666
(703) 492-4140
(703) 490-6443
Mailing address
PO BOX 2010, MERRIFIELD, VA 22116-2010
(703) 492-4140
(703) 492-5409
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
0101053252
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
269480
ANTHEM
VA
01
—
7371099
AETNA
VA
01
—
8297441
CIGNA
VA
01
—
F502
CAREFIRST
VA
Enumeration date
10/24/2007
Last updated
09/24/2008
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