Provider Demographics
NPI:1780629584
Name:CENTER FOR MEDICAL DERMATOLOGY
Entity Type:Organization
Organization Name:CENTER FOR MEDICAL DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-442-0301
Mailing Address - Street 1:8301 OLD COURT HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3804
Mailing Address - Country:US
Mailing Address - Phone:703-442-0301
Mailing Address - Fax:703-442-0337
Practice Address - Street 1:8301 OLD COURT HOUSE RD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182
Practice Address - Country:US
Practice Address - Phone:703-442-0301
Practice Address - Fax:703-442-0337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADC2111OtherRAILROAD MEDICARE
VAG01491Medicare PIN