Provider Demographics
NPI:1396954715
Name:DERMATOLOGY INC. OF VIRGINIA BEACH
Entity type:Organization
Organization Name:DERMATOLOGY INC. OF VIRGINIA BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HARR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-481-4422
Mailing Address - Street 1:1200 FIRST COLONIAL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2207
Mailing Address - Country:US
Mailing Address - Phone:757-481-4422
Mailing Address - Fax:757-481-9182
Practice Address - Street 1:1200 FIRST COLONIAL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2207
Practice Address - Country:US
Practice Address - Phone:757-481-4422
Practice Address - Fax:757-481-9182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1288OtherANTHEM BLUE SHIELD GR.#
VAC01672Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER