Provider Demographics
NPI:1437352788
Name:UNIVERSITY DERMATOLOGY ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:UNIVERSITY DERMATOLOGY ASSOCIATES, PLLC
Other - Org Name:RADHA MIKKILINENI, MD, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RADHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKKILINENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-955-6995
Mailing Address - Street 1:1120 19TH ST NW
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-3605
Mailing Address - Country:US
Mailing Address - Phone:202-955-6995
Mailing Address - Fax:202-955-3915
Practice Address - Street 1:1120 19TH ST NW
Practice Address - Street 2:SUITE 250
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3605
Practice Address - Country:US
Practice Address - Phone:202-955-6995
Practice Address - Fax:202-955-3915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty