Provider Demographics
NPI:1073151866
Name:VIRGIN ISLANDS DERMATOLOGY, INC.
Entity Type:Organization
Organization Name:VIRGIN ISLANDS DERMATOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EVETH
Authorized Official - Middle Name:
Authorized Official - Last Name:VIALET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:340-776-2544
Mailing Address - Street 1:PO BOX 11366
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00801-4366
Mailing Address - Country:US
Mailing Address - Phone:340-776-2544
Mailing Address - Fax:
Practice Address - Street 1:9150 ESTATE THOMAS STE 106
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2612
Practice Address - Country:US
Practice Address - Phone:340-776-2544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty