Provider Demographics
NPI:1508007840
Name:JAMES RIVER DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:JAMES RIVER DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:REGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-379-0116
Mailing Address - Street 1:PO BOX 72605
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-8017
Mailing Address - Country:US
Mailing Address - Phone:804-379-0116
Mailing Address - Fax:804-379-1088
Practice Address - Street 1:1316 ALVERSER PLAZA
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113
Practice Address - Country:US
Practice Address - Phone:804-379-0116
Practice Address - Fax:804-379-1088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238821207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty