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General NPI Number Information
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NPI Number | 1023484219
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Entity Type | Organization
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Legal Business Name | SHENANDOAH DERMATOLOGY, P.C.
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Dates
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Enumeration Date | 08/11/2015
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Last Update Date | 08/05/2020
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Provider Practice Location Address
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Address Line | 1600 N COALTER ST SUITE 19
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City | STAUNTON
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State | VA
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Zip | 24401-2551
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Country | US
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Telephone | 540-885-4500
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Fax | 540-885-4600
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Provider Business Mailing Address
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Address Line | 1600 N COALTER ST SUITE 19
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City | STAUNTON
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State | VA
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Zip | 24401-2551
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Country | US
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Telephone | 540-885-4500
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Fax | 540-885-4600
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | DR. JANE M LYNCH
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Credential | MD
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Telephone | 540-885-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 101228437
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License Number State | VA
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