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General NPI Number Information
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NPI Number | 1275723843
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Entity Type | Organization
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Legal Business Name | PREMIER DERMATOLOGY, P.C.
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | 44121 HARRY BYRD HWY SUITE 210
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City | ASHBURN
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State | VA
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Zip | 20147-5667
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Country | US
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Telephone | 703-726-0070
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Fax | 703-726-0935
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Provider Business Mailing Address
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Address Line | 44121 HARRY BYRD HWY SUITE 210
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City | ASHBURN
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State | VA
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Zip | 20147-5667
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Country | US
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Telephone | 703-726-0070
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Fax | 703-726-0935
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Authorized Official
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Title or Position | PRESIDENT
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Name | ADIL USMAN
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Credential | M.D.
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Telephone | 703-994-2406
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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 | 0101237514
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License Number State | VA
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