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General NPI Number Information
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NPI Number | 1134536832
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY ASSOCIATES OF ROANOKE
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 07/15/2014
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Provider Practice Location Address
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Address Line | 1215 3RD ST SW
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City | ROANOKE
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State | VA
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Zip | 24016-4611
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Country | US
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Telephone | 540-345-6010
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Fax | 540-345-5446
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Provider Business Mailing Address
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Address Line | 1215 3RD ST SW
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City | ROANOKE
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State | VA
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Zip | 24016-4611
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Country | US
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Telephone | 540-345-6010
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Fax | 540-345-5446
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SUSIE R CRAIG
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Credential |
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Telephone | 540-345-6010
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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 | 0101049323
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License Number State | VA
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