Provider Demographics
NPI:1255677555
Name:DERM ONE PLLC
Entity Type:Organization
Organization Name:DERM ONE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:TOLLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:276-326-3376
Mailing Address - Street 1:34 NEW HOPE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2354
Mailing Address - Country:US
Mailing Address - Phone:304-425-9448
Mailing Address - Fax:304-431-2589
Practice Address - Street 1:34 NEW HOPE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2354
Practice Address - Country:US
Practice Address - Phone:304-425-9448
Practice Address - Fax:304-431-2589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty