Provider Demographics
NPI:1518329234
Name:ADVANCED SKIN AND LASER CENTER OF RICHMOND
Entity Type:Organization
Organization Name:ADVANCED SKIN AND LASER CENTER OF RICHMOND
Other - Org Name:CAROL BYRD, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-740-9549
Mailing Address - Street 1:204 GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-7074
Mailing Address - Country:US
Mailing Address - Phone:804-740-9549
Mailing Address - Fax:
Practice Address - Street 1:201 CONCOURSE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5640
Practice Address - Country:US
Practice Address - Phone:804-549-4025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101036110208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty