Provider Demographics
NPI:1689950610
Name:DAL DERMATOLOGY, INC.
Entity Type:Organization
Organization Name:DAL DERMATOLOGY, INC.
Other - Org Name:DAMASCUS DERMATOLOGY & SKIN SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-253-1100
Mailing Address - Street 1:8510 BEECH TREE RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2949
Mailing Address - Country:US
Mailing Address - Phone:301-253-1100
Mailing Address - Fax:301-825-5163
Practice Address - Street 1:26215 RIDGE RD
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-1829
Practice Address - Country:US
Practice Address - Phone:301-253-1100
Practice Address - Fax:301-825-5163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-21
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0071594207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty