Provider Demographics
NPI:1679755789
Name:ZEN LO DERMATOLOGY, INC
Entity Type:Organization
Organization Name:ZEN LO DERMATOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ROYAL
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-934-0060
Mailing Address - Street 1:10120 WEST BROAD STREET
Mailing Address - Street 2:SUITE R
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060
Mailing Address - Country:US
Mailing Address - Phone:804-934-0060
Mailing Address - Fax:
Practice Address - Street 1:10120 WEST BROAD STREET
Practice Address - Street 2:SUITE R
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060
Practice Address - Country:US
Practice Address - Phone:804-934-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051656174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADD7147OtherMEDICARE RAILROAD
VA183408OtherANTHEM
VAC09951OtherMEDICARE GROUP
VA183408OtherANTHEM