Healthcare Provider Details

I. General information

NPI: 1003440355
Provider Name (Legal Business Name): ABSOLUTE DERMATOLOGY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 08/26/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 WILKES RIDGE DR STE 200
HENRICO VA
23233-7963
US

IV. Provider business mailing address

1206 PORTER ST UNIT B
RICHMOND VA
23224-2107
US

V. Phone/Fax

Practice location:
  • Phone: 804-326-4448
  • Fax: 309-326-4947
Mailing address:
  • Phone: 757-897-5236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WILLIAM SPENCER GILLEN
Title or Position: MOHS SURGEON
Credential: MD
Phone: 757-897-5236