Provider Demographics
NPI:1033553862
Name:DERMONE DERMATOLOGY ASSOCIATES OF VIRGINIA PC
Entity Type:Organization
Organization Name:DERMONE DERMATOLOGY ASSOCIATES OF VIRGINIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:COLE
Authorized Official - Last Name:LENNERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-251-9944
Mailing Address - Street 1:405 OAK LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-1633
Mailing Address - Country:US
Mailing Address - Phone:910-251-9944
Mailing Address - Fax:910-251-5011
Practice Address - Street 1:405 OAK LN
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-1633
Practice Address - Country:US
Practice Address - Phone:910-251-9944
Practice Address - Fax:910-251-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203024207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty