Provider Demographics
NPI:1316016470
Name:CHARLOTTESVILLE DERMATOLOGY
Entity Type:Organization
Organization Name:CHARLOTTESVILLE DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAGEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-984-2400
Mailing Address - Street 1:600 PETER JEFFERSON PARKWAY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911
Mailing Address - Country:US
Mailing Address - Phone:434-984-2400
Mailing Address - Fax:434-984-1147
Practice Address - Street 1:600 PETER JEFFERSON PARKWAY
Practice Address - Street 2:SUITE 230
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911
Practice Address - Country:US
Practice Address - Phone:434-984-2400
Practice Address - Fax:434-984-1147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty