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General NPI Number Information
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NPI Number | 1538240486
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Entity Type | Organization
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Legal Business Name | PIEDMONT DERMATOLOGY CENTER, PC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 10/03/2011
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Provider Practice Location Address
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Address Line | 314 FAIRY STREET EXT SUITE D
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City | MARTINSVILLE
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State | VA
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Zip | 24112-1913
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Country | US
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Telephone | 276-666-8439
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Fax | 276-666-8440
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Provider Business Mailing Address
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Address Line | 314 FAIRY STREET EXT SUITE D
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City | MARTINSVILLE
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State | VA
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Zip | 24112-1913
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Country | US
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Telephone | 276-666-8439
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Fax | 276-666-8440
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Authorized Official
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Title or Position | PRESIDENT/MEDICAL DOCTOR
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Name | DR. NED JAY GROSS
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Credential | M.D.
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Telephone | 276-666-8439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101228761
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License Number State | VA
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