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General NPI Number Information
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NPI Number | 1356821235
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Entity Type | Organization
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Legal Business Name | SDM VIRGINIA LLC
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Dates
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Enumeration Date | 08/20/2018
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 4198 COX RD STE 109
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City | GLEN ALLEN
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State | VA
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Zip | 23060-3328
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Country | US
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Telephone | 804-967-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 3340 ROBINWOOD RD
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City | GASTONIA
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State | NC
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Zip | 28054-6689
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Country | US
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Telephone | 980-233-3234
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DAVID L BRYANT
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Credential |
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Telephone | 980-233-3200
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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 |
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License Number State |
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