Healthcare Provider Details

I. General information

NPI: 1649443367
Provider Name (Legal Business Name): SKIN SURGERY CENTER OF VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2008
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 GASKINS RD
HENRICO VA
23238-1481
US

IV. Provider business mailing address

2510 GASKINS ROAD
HENRICO VA
23238-1481
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-4940
  • Fax: 804-282-4941
Mailing address:
  • Phone: 804-282-4940
  • Fax: 804-282-4941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. CHRISTINE S. RAUSCH
Title or Position: PHYSICIAN, OWNER
Credential: MD
Phone: 804-282-4940