Provider Demographics
NPI:1659313773
Name:LASER SKIN & VEIN CENTER OF VIRGINIA
Entity Type:Organization
Organization Name:LASER SKIN & VEIN CENTER OF VIRGINIA
Other - Org Name:LASER CENTER OF VIRGINIA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-437-8900
Mailing Address - Street 1:933 FIRST COLONIAL ROAD S
Mailing Address - Street 2:113
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454
Mailing Address - Country:US
Mailing Address - Phone:757-437-8900
Mailing Address - Fax:757-437-8200
Practice Address - Street 1:933 FIRST COLONIAL ROAD S
Practice Address - Street 2:113
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454
Practice Address - Country:US
Practice Address - Phone:757-437-8900
Practice Address - Fax:757-437-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041249207N00000X
VA0101035339207N00000X
VA01012357232082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Not Answered2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00958L51Medicare ID - Type Unspecified
H85423Medicare UPIN
G65397Medicare UPIN
B07698Medicare UPIN
VA003270L51Medicare ID - Type Unspecified