Provider Demographics
NPI:1669497962
Name:CENTRAL VIRGINIA DERMATOLOGY
Entity Type:Organization
Organization Name:CENTRAL VIRGINIA DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:COLEMAN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-385-1982
Mailing Address - Street 1:2203 GRAVES MILL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4296
Mailing Address - Country:US
Mailing Address - Phone:434-385-1982
Mailing Address - Fax:434-385-1985
Practice Address - Street 1:2203 GRAVES MILL RD
Practice Address - Street 2:SUITE A
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4296
Practice Address - Country:US
Practice Address - Phone:434-385-1982
Practice Address - Fax:434-385-1985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037565207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA332282OtherANTHEM
VA332282OtherANTHEM