Provider Demographics
NPI:1417349747
Name:COLUMBIA DERMATOLOGY LLC
Entity Type:Organization
Organization Name:COLUMBIA DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:BURGY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-894-4582
Mailing Address - Street 1:2241 BUSH RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-5626
Mailing Address - Country:US
Mailing Address - Phone:304-894-4582
Mailing Address - Fax:
Practice Address - Street 1:2241 BUSH RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5626
Practice Address - Country:US
Practice Address - Phone:304-894-4582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty