Provider Demographics
NPI:1538502828
Name:COMPLEXIONS DERMATOLOGY, PC
Entity Type:Organization
Organization Name:COMPLEXIONS DERMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:434-792-0423
Mailing Address - Street 1:117 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4101
Mailing Address - Country:US
Mailing Address - Phone:434-792-0423
Mailing Address - Fax:434-791-4694
Practice Address - Street 1:117 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4101
Practice Address - Country:US
Practice Address - Phone:434-792-0423
Practice Address - Fax:434-791-4694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203385207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty