Provider Demographics
NPI:1134536832
Name:DERMATOLOGY ASSOCIATES OF ROANOKE
Entity type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF ROANOKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-345-6010
Mailing Address - Street 1:1215 3RD ST SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4611
Mailing Address - Country:US
Mailing Address - Phone:540-345-6010
Mailing Address - Fax:540-345-5446
Practice Address - Street 1:1215 3RD ST SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4611
Practice Address - Country:US
Practice Address - Phone:540-345-6010
Practice Address - Fax:540-345-5446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049323174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty