Provider Demographics
NPI:1033390695
Name:DERMATOLOGY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:REGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-408-1540
Mailing Address - Street 1:110 IRVING ST NW # 2B28
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-3017
Mailing Address - Country:US
Mailing Address - Phone:301-408-1540
Mailing Address - Fax:301-408-1455
Practice Address - Street 1:110 IRVING ST NW # 2B28
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3017
Practice Address - Country:US
Practice Address - Phone:301-408-1540
Practice Address - Fax:301-408-1455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC166099D84Medicare PIN