Provider Demographics
NPI:1831123827
Name:WILLIAMSBURG DERMATOLOGY INC
Entity Type:Organization
Organization Name:WILLIAMSBURG DERMATOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:W
Authorized Official - Last Name:MUSGRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-220-2266
Mailing Address - Street 1:1139 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3329
Mailing Address - Country:US
Mailing Address - Phone:757-220-2266
Mailing Address - Fax:
Practice Address - Street 1:1139 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3329
Practice Address - Country:US
Practice Address - Phone:757-220-2266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty