Provider Demographics
NPI:1811371685
Name:DERMONE
Entity Type:Organization
Organization Name:DERMONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:TOLLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:276-326-3376
Mailing Address - Street 1:725 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-1640
Mailing Address - Country:US
Mailing Address - Phone:276-326-3376
Mailing Address - Fax:
Practice Address - Street 1:603 BEAMAN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2650
Practice Address - Country:US
Practice Address - Phone:910-590-1049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-12
Last Update Date:2015-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty