Basic Information
| Provider Information | |||||||||
| NPI: | 1902091101 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VIRGINIAS DERMATOLOGY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34 NEW HOPE RD | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 247402354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2763263376 | ||||||||
| FaxNumber: | 2763263046 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 COUNTRY CLUB HL | ||||||||
| Address2: | |||||||||
| City: | BLUEFIELD | ||||||||
| State: | WV | ||||||||
| PostalCode: | 247014467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2763263376 | ||||||||
| FaxNumber: | 2763263046 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2007 | ||||||||
| LastUpdateDate: | 06/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | TOLLIVER | ||||||||
| AuthorizedOfficialFirstName: | TERESA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2763263376 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.