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General NPI Number Information
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NPI Number | 1437352788
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Entity Type | Organization
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Legal Business Name | UNIVERSITY DERMATOLOGY ASSOCIATES, PLLC
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 1120 19TH ST NW SUITE 250
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City | WASHINGTON
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State | DC
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Zip | 20036-3605
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Country | US
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Telephone | 202-955-6995
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Fax | 202-955-3915
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Provider Business Mailing Address
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Address Line | 1120 19TH ST NW SUITE 250
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City | WASHINGTON
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State | DC
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Zip | 20036-3605
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Country | US
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Telephone | 202-955-6995
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Fax | 202-955-3915
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Authorized Official
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Title or Position | OWNER
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Name | DR. RADHA MIKKILINENI
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Credential | MD
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Telephone | 202-955-6995
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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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