Provider Demographics
NPI:1942772082
Name:BECKLEY DERMATOLOGY INC.
Entity Type:Organization
Organization Name:BECKLEY DERMATOLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:E
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-252-2673
Mailing Address - Street 1:136 LINDEN DR STE 104
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6900
Mailing Address - Country:US
Mailing Address - Phone:540-678-3588
Mailing Address - Fax:540-678-9025
Practice Address - Street 1:1401 HOSPITAL DR STE 101
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9239
Practice Address - Country:US
Practice Address - Phone:681-235-7253
Practice Address - Fax:681-235-7258
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BECKLEY DERMATOLOGY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty