Provider Demographics
NPI:1083688238
Name:DERMATOLOGY SPECIALISTS OF VIRGINIA PC
Entity Type:Organization
Organization Name:DERMATOLOGY SPECIALISTS OF VIRGINIA PC
Other - Org Name:SEBASTIEN DERMATOLOGY PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:SEBASTIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-709-1492
Mailing Address - Street 1:1800 TOWN CENTER DR
Mailing Address - Street 2:STE 415
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190
Mailing Address - Country:US
Mailing Address - Phone:703-709-1492
Mailing Address - Fax:703-709-5111
Practice Address - Street 1:1800 TOWN CENTER DR
Practice Address - Street 2:STE 415
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190
Practice Address - Country:US
Practice Address - Phone:703-709-1492
Practice Address - Fax:703-709-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty