Basic Information
| Provider Information | |||||||||
| NPI: | 1316952716 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DERMATOLOGY ASSOCIATES OF RICHMOND PC | ||||||||
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| OtherOrganizationName: | DERMATOLOGY ASSOCIATES OF RICHMOND | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 CONCOURSE BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | GLEN ALLEN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230595640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045494030 | ||||||||
| FaxNumber: | 8045494032 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 CONCOURSE BLVD STE 110 | ||||||||
| Address2: | |||||||||
| City: | GLEN ALLEN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045494025 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 09/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | CROUCH | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 8049396186 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | CF1973 | 01 | VA | RAILROAD MEDICARE | OTHER | 064912 | 01 | VA | ANTHEM | OTHER |