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General NPI Number Information
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NPI Number | 1255791448
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY ASSOCIATES OF NORTHERN VIRGINIA
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Dates
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Enumeration Date | 03/01/2016
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Last Update Date | 03/01/2016
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Provider Practice Location Address
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Address Line | 25055 RIDING PLZ SUITE 230
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City | CHANTILLY
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State | VA
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Zip | 20152-5917
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Country | US
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Telephone | 703-222-2773
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Fax | 703-222-6093
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Provider Business Mailing Address
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Address Line | 13880 BRADDOCK RD STE 301
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City | CENTREVILLE
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State | VA
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Zip | 20121-2462
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Country | US
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Telephone | 703-222-2773
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Fax | 703-222-6093
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. ANITA JUNE NEELY
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Credential |
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Telephone | 703-222-2773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 0101047432
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License Number State | VA
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