Provider Demographics
NPI:1609912112
Name:ASSOCIATES IN DERMATOLOGY, INC.
Entity Type:Organization
Organization Name:ASSOCIATES IN DERMATOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:COKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:757-838-8030
Mailing Address - Street 1:17 MANHATTAN SQ
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5843
Mailing Address - Country:US
Mailing Address - Phone:757-838-8030
Mailing Address - Fax:757-838-8413
Practice Address - Street 1:17 MANHATTAN SQ
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5843
Practice Address - Country:US
Practice Address - Phone:757-838-8030
Practice Address - Fax:757-838-8413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101020320207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101225840OtherLESLIE R. COKER, MD
VA0101020320OtherWILLIAM L.COKER, JR, MD
VA010004055Medicaid
VA005930936Medicaid
VAB07181Medicare UPIN
VAC08687Medicare PIN
VA010004055Medicaid