Provider Demographics
NPI:1023550654
Name:JAMES RIVER DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:JAMES RIVER DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:REGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-379-0116
Mailing Address - Street 1:PO BOX 72605
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-8017
Mailing Address - Country:US
Mailing Address - Phone:804-379-0116
Mailing Address - Fax:804-379-1088
Practice Address - Street 1:6372 MECHANICSVILLE TPKE STE 103
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111
Practice Address - Country:US
Practice Address - Phone:804-379-0116
Practice Address - Fax:804-379-1088
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMES RIVER DERMATOLOGY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-14
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238821207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty