Provider Demographics
NPI:1255526901
Name:CENTER FOR DERMATOLOGY & DERMATOLOGIC SURGERY P C
Entity type:Organization
Organization Name:CENTER FOR DERMATOLOGY & DERMATOLOGIC SURGERY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-955-5757
Mailing Address - Street 1:2311 M STREET, NW
Mailing Address - Street 2:SUITE 504
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1445
Mailing Address - Country:US
Mailing Address - Phone:202-955-5757
Mailing Address - Fax:202-955-5797
Practice Address - Street 1:2311 M STREET, NW
Practice Address - Street 2:SUITE 504
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1445
Practice Address - Country:US
Practice Address - Phone:202-955-5757
Practice Address - Fax:202-955-5797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG00005OtherMEDICARE
DCG00005OtherMEDICARE