=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376967497
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DERMATOLOGY CENTER OF RICHMOND PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2014
-----------------------------------------------------
Last Update Date | 02/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7650 E PARHAM RD SUITE 200
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23294-4373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-916-7062
-----------------------------------------------------
Fax | 804-643-2291
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7650 E PARHAM RD SUITE 200
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23294-4373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-916-7062
-----------------------------------------------------
Fax | 804-643-2291
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | HAYRI SANGIRAY
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 804-916-7062
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 0102201569
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------