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General NPI Number Information
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NPI Number | 1003304874
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Entity Type | Organization
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Legal Business Name | DERMUTOPIA PLLC
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Dates
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Enumeration Date | 04/27/2018
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Last Update Date | 09/26/2019
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Provider Practice Location Address
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Address Line | 370 MAPLE AVE W STE V
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City | VIENNA
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State | VA
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Zip | 22180-5615
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Country | US
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Telephone | 703-229-2544
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 227
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City | VIENNA
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State | VA
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Zip | 22183-0227
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Country | US
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Telephone | 703-229-2544
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRENDA J DINTIMAN
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Credential | MD
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Telephone | 703-229-2544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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