Healthcare Provider Details

I. General information

NPI: 1659313773
Provider Name (Legal Business Name): LASER SKIN & VEIN CENTER OF VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 FIRST COLONIAL ROAD S 113
VIRGINIA BEACH VA
23454
US

IV. Provider business mailing address

933 FIRST COLONIAL ROAD S 113
VIRGINIA BEACH VA
23454
US

V. Phone/Fax

Practice location:
  • Phone: 757-437-8900
  • Fax: 757-437-8200
Mailing address:
  • Phone: 757-437-8900
  • Fax: 757-437-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101041249
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number0101235723
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101035339
License Number StateVA

VIII. Authorized Official

Name: DR. DAVID HENRY MCDANIEL
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 757-437-8900