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General NPI Number Information
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NPI Number | 1891267936
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Entity Type | Organization
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Legal Business Name | BECKLEY DERMATOLOGY INC.
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Dates
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Enumeration Date | 12/31/2018
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Last Update Date | 12/31/2018
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Provider Practice Location Address
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Address Line | 1110 PROFESSIONAL CT STE 201
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City | HAGERSTOWN
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State | MD
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Zip | 21740-5945
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Country | US
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Telephone | 240-707-6920
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Fax | 240-707-6926
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Provider Business Mailing Address
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Address Line | 136 LINDEN DR STE 104
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City | WINCHESTER
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State | VA
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Zip | 22601-6900
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Country | US
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Telephone | 540-678-3588
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Fax | 540-678-9025
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Authorized Official
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Title or Position | OWNER
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Name | NELSON E. VELAZQUEZ
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Credential | DO
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Telephone | 304-252-2673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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