Provider Demographics
NPI:1003440355
Name:ABSOLUTE DERMATOLOGY P.C.
Entity Type:Organization
Organization Name:ABSOLUTE DERMATOLOGY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MOHS SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:GILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-897-5236
Mailing Address - Street 1:1206 PORTER ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-2107
Mailing Address - Country:US
Mailing Address - Phone:757-897-5236
Mailing Address - Fax:
Practice Address - Street 1:5207 HICKORY PARK DR STE A
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-2624
Practice Address - Country:US
Practice Address - Phone:804-601-6126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty