Healthcare Provider Details

I. General information

NPI: 1568441897
Provider Name (Legal Business Name): DERMATOLOGIC SURGERY OF CENTRAL VIRGINIA PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 E JEFFERSON ST SUITE 201
CHARLOTTESVILLE VA
22902-5397
US

IV. Provider business mailing address

PO BOX 826696
PHILADELPHIA PA
19182-6696
US

V. Phone/Fax

Practice location:
  • Phone: 434-979-7700
  • Fax: 434-979-7715
Mailing address:
  • Phone: 434-979-7700
  • Fax: 434-979-7715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN D HENDRIX JR.
Title or Position: OWNER
Credential: MD
Phone: 434-979-7700