Provider Demographics
NPI:1154442051
Name:DERMATOLOGY AND DERMATOLOGIC SURGERY, INC.
Entity Type:Organization
Organization Name:DERMATOLOGY AND DERMATOLOGIC SURGERY, INC.
Other - Org Name:THE CENTER FOR DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAUNDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-846-0076
Mailing Address - Street 1:8505 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4621
Mailing Address - Country:US
Mailing Address - Phone:703-846-0076
Mailing Address - Fax:703-846-0025
Practice Address - Street 1:8505 ARLINGTON BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4621
Practice Address - Country:US
Practice Address - Phone:703-846-0076
Practice Address - Fax:703-846-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101230540174400000X
MDD0053142174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA462795Medicare UPIN
VA460876Medicare UPIN
VAF1930001Medicare UPIN
VA9787637Medicare UPIN
VA491142Medicare ID - Type Unspecified
VA5462690Medicare UPIN