Healthcare Provider Details

I. General information

NPI: 1982760963
Provider Name (Legal Business Name): WASHINGTON DERMATOLOGY CONSULTANTS, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 S CARLIN SPRINGS RD SUITE 406
ARLINGTON VA
22204-1064
US

IV. Provider business mailing address

611 S CARLIN SPRINGS RD SUITE 406
ARLINGTON VA
22204-1064
US

V. Phone/Fax

Practice location:
  • Phone: 571-431-6175
  • Fax: 571-431-6179
Mailing address:
  • Phone: 571-431-6175
  • Fax: 571-431-6179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number0101237321
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number0101237321
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101237321
License Number StateVA

VIII. Authorized Official

Name: DR. KENNETH W NEAL
Title or Position: DIRECTOR OF DERMATOLOGIC SURGERY
Credential: MD
Phone: 571-431-6175