Provider Demographics
NPI:1497032205
Name:VIRGINIA DERMATOLOGY SKIN CANCER CENTER SUFFOLK
Entity Type:Organization
Organization Name:VIRGINIA DERMATOLOGY SKIN CANCER CENTER SUFFOLK
Other - Org Name:VIRGINIA DERMATOLOGY AND SKIN CANCER CENTER SUFFOLK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANI
Authorized Official - Middle Name:N
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-455-5009
Mailing Address - Street 1:1005 COMMERCIAL LN
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8149
Mailing Address - Country:US
Mailing Address - Phone:757-925-1890
Mailing Address - Fax:
Practice Address - Street 1:1005 COMMERCIAL LN
Practice Address - Street 2:SUITE 230
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8149
Practice Address - Country:US
Practice Address - Phone:757-925-1890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty