49D2077772 CLIA NUMBER - RENEWAL DERMATOLOGY & MEDSPA

Laboratory Demographics

  • CLIA Code: 49D2077772
  • Facility Name: RENEWAL DERMATOLOGY & MEDSPA
  • Facility Address: 1850 TOWN CENTER PARKWAY - PAVILION II SUITE 360
    RESTON, VA
    ZIP 20190
  • Facility Phone: 703 753-9860
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: KURT L. MAGGIO
  • NPI Number: 1831324144
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 49D2077772
LAB Type Physician Office
Facility Name RENEWAL DERMATOLOGY & MEDSPA
Street 1850 TOWN CENTER PARKWAY - PAVILION II SUITE 360
City RESTON
State VA
ZIP 20190
Phone 703 753-9860
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 11/3/2024
Certificate Expiration Date 11/2/2026
Facility Type Physician Office
Lab Director KURT L. MAGGIO

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This page was last updated on: 3/20/2025