Provider Demographics
NPI:1467534248
Name:NEW RIVER DERMATOLOGY PLC
Entity Type:Organization
Organization Name:NEW RIVER DERMATOLOGY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:HURD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:540-953-2210
Mailing Address - Street 1:2617 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-8271
Mailing Address - Country:US
Mailing Address - Phone:540-953-2210
Mailing Address - Fax:540-951-9112
Practice Address - Street 1:2617 SHEFFIELD DR
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-8271
Practice Address - Country:US
Practice Address - Phone:540-953-2210
Practice Address - Fax:540-951-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201003207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA01391200002OtherQUAL CHOICE
VA140785OtherTRIGON
VACH9865OtherRR MEDICARE GROUP ID
VA5901928Medicaid
VACH9865OtherRR MEDICARE GROUP ID