Healthcare Provider Details

I. General information

NPI: 1801973169
Provider Name (Legal Business Name): ALBEMARLE DERMATOLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 BERKMAR DR
CHARLOTTESVILLE VA
22901-1491
US

IV. Provider business mailing address

3350 BERKMAR DR
CHARLOTTESVILLE VA
22901-1491
US

V. Phone/Fax

Practice location:
  • Phone: 434-923-4651
  • Fax: 434-964-3636
Mailing address:
  • Phone: 434-923-4651
  • Fax: 434-964-3636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101042830
License Number StateVA

VIII. Authorized Official

Name: DR. BONNIE F STRAKA
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 434-923-4651