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General NPI Number Information
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NPI Number | 1033021662
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Entity Type | Organization
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Legal Business Name | MOHS SURGERY CENTER OF RICHMOND DERMATOLOGY, PLLC
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Dates
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Enumeration Date | 09/18/2026
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Last Update Date | 09/18/2026
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Provider Practice Location Address
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Address Line | 3829 GASKINS RD
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City | RICHMOND
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State | VA
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Zip | 23233-1437
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Country | US
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Telephone | 804-538-1033
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Fax | 866-274-0799
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Provider Business Mailing Address
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Address Line | 9816 MAYLAND DR
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City | RICHMOND
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State | VA
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Zip | 23233-1457
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Country | US
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Telephone | 804-286-4927
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Fax | 804-285-5750
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. MATTHEW MALONE WALLACE
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Credential | MD
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Telephone | 703-431-9519
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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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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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