Provider Demographics
NPI:1669069266
Name:CITY DERMATOLOGY OF NORTHERN VIRGINIA LLC
Entity type:Organization
Organization Name:CITY DERMATOLOGY OF NORTHERN VIRGINIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-343-1064
Mailing Address - Street 1:PO BOX 50608
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-5608
Mailing Address - Country:US
Mailing Address - Phone:703-343-1064
Mailing Address - Fax:659-204-4572
Practice Address - Street 1:407 N WASHINGTON ST STE 104
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3436
Practice Address - Country:US
Practice Address - Phone:703-343-1064
Practice Address - Fax:659-204-4572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCFK2015027OtherDEA CERTIFICATE