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General NPI Number Information
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NPI Number | 1215444377
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Entity Type | Organization
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Legal Business Name | BARCROFT DERMATOLOGY, LLC
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Dates
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Enumeration Date | 01/10/2018
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Last Update Date | 12/04/2018
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Provider Practice Location Address
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Address Line | 939 S WAKEFIELD ST
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City | ARLINGTON
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State | VA
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Zip | 22204-3084
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Country | US
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Telephone | 703-892-3636
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Fax | 703-892-3626
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Provider Business Mailing Address
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Address Line | 727 MCKINLEY ST NE
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City | VIENNA
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State | VA
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Zip | 22180-3405
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Country | US
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Telephone | 703-281-3626
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Fax | 703-281-3615
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAI HOANG NGUYEN
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Credential | MD
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Telephone | 703-892-3636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0101244058
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License Number State | VA
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