Provider Demographics
NPI:1396774667
Name:VIRGINIA DERMATOLOGY & SKIN CANCER CENTER PLLC
Entity type:Organization
Organization Name:VIRGINIA DERMATOLOGY & SKIN CANCER CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-455-5009
Mailing Address - Street 1:241 CORPORATE BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4954
Mailing Address - Country:US
Mailing Address - Phone:757-455-5009
Mailing Address - Fax:757-362-3577
Practice Address - Street 1:9724 BAY POINT DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-2013
Practice Address - Country:US
Practice Address - Phone:757-404-7725
Practice Address - Fax:757-362-3577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042937261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty