Provider Demographics
NPI:1568674133
Name:DERMATOLOGY CONSULTANTS OF GLOUCESTER P L L C
Entity Type:Organization
Organization Name:DERMATOLOGY CONSULTANTS OF GLOUCESTER P L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:MUFFELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-693-6527
Mailing Address - Street 1:PO BOX 693
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061
Mailing Address - Country:US
Mailing Address - Phone:804-693-6527
Mailing Address - Fax:804-693-6615
Practice Address - Street 1:6790 WOOD RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061
Practice Address - Country:US
Practice Address - Phone:804-693-6527
Practice Address - Fax:804-693-6615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026776174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA141598OtherANTHEM BCBS GROUP NUMBER
VACJ9476OtherRAILROAD MEDICARE
VAC08338Medicare PIN