Provider Demographics
NPI:1205041852
Name:DOMINION DERMATOLOGY ASSOCIATES P.C.
Entity Type:Organization
Organization Name:DOMINION DERMATOLOGY ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAUNCEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCHARGUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-825-6290
Mailing Address - Street 1:1100 SUNSET LN
Mailing Address - Street 2:SUITE 1212
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3307
Mailing Address - Country:US
Mailing Address - Phone:540-825-6290
Mailing Address - Fax:540-825-7629
Practice Address - Street 1:1100 SUNSET LN
Practice Address - Street 2:SUITE 1212
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3307
Practice Address - Country:US
Practice Address - Phone:540-825-6290
Practice Address - Fax:540-825-7629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045612207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAGC1023Medicare PIN