Provider Demographics
NPI:1205212933
Name:DERMATOLOGY OF VIRGINIA
Entity Type:Organization
Organization Name:DERMATOLOGY OF VIRGINIA
Other - Org Name:DERMVIRGINIA
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LIANA
Authorized Official - Middle Name:I
Authorized Official - Last Name:ABRAMOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-239-1872
Mailing Address - Street 1:3930 PENDER DR STE 210
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-0992
Mailing Address - Country:US
Mailing Address - Phone:703-828-7128
Mailing Address - Fax:703-825-7718
Practice Address - Street 1:3930 PENDER DR
Practice Address - Street 2:SUITE 210
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-0985
Practice Address - Country:US
Practice Address - Phone:703-828-7128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101245322207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty