Provider Demographics
NPI:1437644341
Name:VIRGINIA DERMATOLOGY & SKIN SURGERY CENTER
Entity Type:Organization
Organization Name:VIRGINIA DERMATOLOGY & SKIN SURGERY CENTER
Other - Org Name:VIRGINIA DERMATOLOGY & SKIN SURGERY CENTER LAB
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:EID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-373-6647
Mailing Address - Street 1:1985 JEFFERSON DAVIS HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401
Mailing Address - Country:US
Mailing Address - Phone:540-373-6647
Mailing Address - Fax:540-479-1656
Practice Address - Street 1:1985 JEFFERSON DAVIS HIGHWAY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401
Practice Address - Country:US
Practice Address - Phone:540-373-6647
Practice Address - Fax:540-479-1656
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRGINIA DERMATOLOGY AND SKIN SURGERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZC0008XAllopathic & Osteopathic PhysiciansPathologyClinical InformaticsGroup - Single Specialty