Provider Demographics
NPI:1922049006
Name:CENTER FOR SKIN SURGERY PLLC
Entity Type:Organization
Organization Name:CENTER FOR SKIN SURGERY PLLC
Other - Org Name:SKIN CANCER OUTPATIENT SURGICAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
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
Mailing Address - Country:US
Mailing Address - Phone:703-442-0300
Mailing Address - Fax:703-442-0332
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:203-442-0300
Practice Address - Fax:703-442-0302
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR SKIN SURGERY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-09
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00265368OtherRAILROAD MEDICARE
VAA00072Medicare PIN