Provider Demographics
NPI:1952338303
Name:ROYAL DERMATOLOGY AND AESTHETIC SKIN CARE, INC.
Entity Type:Organization
Organization Name:ROYAL DERMATOLOGY AND AESTHETIC SKIN CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROYAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-775-0957
Mailing Address - Street 1:505 W LEIGH ST
Mailing Address - Street 2:SUITES 304 & 306
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-3200
Mailing Address - Country:US
Mailing Address - Phone:804-775-0957
Mailing Address - Fax:804-775-0959
Practice Address - Street 1:505 W LEIGH ST
Practice Address - Street 2:SUITES 304 & 306
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-3200
Practice Address - Country:US
Practice Address - Phone:804-775-0957
Practice Address - Fax:804-775-0959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE45972Medicare UPIN