Provider Demographics
NPI:1821439696
Name:TREHERNE DERMATOLOGY AND SKIN C ARE CENTER LLC.
Entity Type:Organization
Organization Name:TREHERNE DERMATOLOGY AND SKIN C ARE CENTER LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNYCE
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:TREHERNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-838-8525
Mailing Address - Street 1:2207 EXECUTIVE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2478
Mailing Address - Country:US
Mailing Address - Phone:757-838-8525
Mailing Address - Fax:757-838-8527
Practice Address - Street 1:2207 EXECUTIVE DR
Practice Address - Street 2:SUITE A
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2478
Practice Address - Country:US
Practice Address - Phone:757-838-8525
Practice Address - Fax:757-838-8527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101247612261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty