Healthcare Provider Details

I. General information

NPI: 1952338303
Provider Name (Legal Business Name): ROYAL DERMATOLOGY AND AESTHETIC SKIN CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W LEIGH ST SUITES 304 & 306
RICHMOND VA
23220-3200
US

IV. Provider business mailing address

505 W LEIGH ST SUITES 304 & 306
RICHMOND VA
23220-3200
US

V. Phone/Fax

Practice location:
  • Phone: 804-775-0957
  • Fax: 804-775-0959
Mailing address:
  • Phone: 804-775-0957
  • Fax: 804-775-0959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. PAMELA J. ROYAL
Title or Position: PHYSICIAN/PRESIDENT
Credential: M.D.
Phone: 804-775-0957