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General NPI Number Information
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NPI Number | 1174799670
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Entity Type | Organization
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Legal Business Name | VIRGINIA BEACH DERMATOLOGY ASSOCIATES PLLC
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Dates
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Enumeration Date | 05/05/2008
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 5320 PROVIDENCE RD STE 202
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4122
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Country | US
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Telephone | 757-523-4800
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Fax | 757-523-5857
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Provider Business Mailing Address
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Address Line | 5320 PROVIDENCE RD STE 202
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4122
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Country | US
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Telephone | 757-523-4800
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Fax | 757-523-5857
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Authorized Official
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Title or Position | BILLING
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Name | MR. BILL RYLL
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Credential |
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Telephone | 757-301-8960
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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 | 0101033623
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License Number State | VA
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