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General NPI Number Information
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NPI Number | 1407078751
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Entity Type | Organization
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Legal Business Name | EXCEL DERMATOLOGY INSTITUTE
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2236C GALLOWS RD
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City | VIENNA
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State | VA
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Zip | 22182-5200
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Country | US
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Telephone | 703-827-7008
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Fax | 703-827-7011
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Provider Business Mailing Address
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Address Line | 2236C GALLOWS RD
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City | VIENNA
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State | VA
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Zip | 22182-5200
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Country | US
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Telephone | 703-827-7008
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Fax | 703-827-7011
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Authorized Official
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Title or Position | OWNER
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Name | DR. DUYEN T FARIA
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Credential | DO
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Telephone | 703-827-7008
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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 | 0102050058
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License Number State | VA
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