Healthcare Provider Details

I. General information

NPI: 1215444377
Provider Name (Legal Business Name): BARCROFT DERMATOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 S WAKEFIELD ST
ARLINGTON VA
22204-3084
US

IV. Provider business mailing address

727 MCKINLEY ST NE
VIENNA VA
22180-3405
US

V. Phone/Fax

Practice location:
  • Phone: 703-892-3636
  • Fax: 703-892-3626
Mailing address:
  • Phone: 703-281-3626
  • Fax: 703-281-3615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number0101244058
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MAI HOANG NGUYEN
Title or Position: OWNER
Credential: MD
Phone: 703-892-3636