Provider Demographics
NPI:1669561791
Name:ADVANCED DERMATOLOGY OF CHARLOTTESVILLE, PLC
Entity type:Organization
Organization Name:ADVANCED DERMATOLOGY OF CHARLOTTESVILLE, PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VANDANA
Authorized Official - Middle Name:SOOD
Authorized Official - Last Name:NANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-977-0027
Mailing Address - Street 1:600 PETER JEFFERSON PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8836
Mailing Address - Country:US
Mailing Address - Phone:434-977-0027
Mailing Address - Fax:434-923-3376
Practice Address - Street 1:600 PETER JEFFERSON PKWY STE 310
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8836
Practice Address - Country:US
Practice Address - Phone:434-977-0027
Practice Address - Fax:434-923-3376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA187666OtherANTHEM
VA413137OtherSOUTHERN HEALTH
VA4368544OtherAETNA US HEALTHCARE
2145994OtherMAMSI LIFE AND HEALTH
VA413137OtherSOUTHERN HEALTH
VA4368544OtherAETNA US HEALTHCARE
VA187666OtherANTHEM
2145994OtherMAMSI LIFE AND HEALTH