Provider Demographics
NPI:1801973169
Name:ALBEMARLE DERMATOLOGY ASSOCIATES, LLC
Entity type:Organization
Organization Name:ALBEMARLE DERMATOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:STRAKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-923-4651
Mailing Address - Street 1:3350 BERKMAR DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1491
Mailing Address - Country:US
Mailing Address - Phone:434-923-4651
Mailing Address - Fax:434-964-3636
Practice Address - Street 1:3350 BERKMAR DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1491
Practice Address - Country:US
Practice Address - Phone:434-923-4651
Practice Address - Fax:434-964-3636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042830207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE50235Medicare UPIN
VAG30615Medicare UPIN
VAG30616Medicare UPIN