Basic Information
| Provider Information | |||||||||
| NPI: | 1518329234 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED SKIN AND LASER CENTER OF RICHMOND | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CAROL BYRD, M.D. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 204 GRANDE DR | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232297074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8047409549 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 CONCOURSE BLVD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | GLEN ALLEN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230595640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045494025 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2016 | ||||||||
| LastUpdateDate: | 09/11/2016 | ||||||||
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| AuthorizedOfficialLastName: | BYRD | ||||||||
| AuthorizedOfficialFirstName: | ANN | ||||||||
| AuthorizedOfficialMiddleName: | CAROL | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN, OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8047409549 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 0101036110 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.