MEDICARE: BECKLEY DERMATOLOGY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207NS0135X	Procedural Dermatology Physician	WV
2	207N00000X	Dermatology Physician	MD
3	207ND0900X	Dermatopathology Physician	WV
4	207ND0101X	MOHS-Micrographic Surgery Physician	WV
5	207N00000X	Dermatology Physician	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720089279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BECKLEY DERMATOLOGY INC.

Provider Business Mailing Address
First Line	:	148 LINDEN DR
Second Line	:	SUITE 101
City	:	WINCHESTER
State	:	VA
Zip	:	22601-6909
Country	:	US
Telephone Number	:	540-504-0066
Fax Number	:	540-678-9025

Provider Business Practice Location Address
First Line	:	94 BROOKSHIRE LANE
Second Line	:
City	:	BECKLEY
State	:	WV
Zip	:	25801-6765
Country	:	US
Telephone Number	:	304-252-2673
Fax Number	:	304-929-2350

Authorized Official
Title or Position	:	SOLE OWNER
Name	:	MR. NELSON E. VELAZQUEZ
Credential	:	DO
Telephone Number	:	304-252-2673

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	02/15/2017

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Directions to “BECKLEY DERMATOLOGY INC. ” Practice Location

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