Provider Demographics
NPI:1215076112
Name:FAMILY DERMATOLOGY OF ALBEMARLE PLC
Entity type:Organization
Organization Name:FAMILY DERMATOLOGY OF ALBEMARLE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:KRASNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-964-9500
Mailing Address - Street 1:215 WAYLES LN
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-4631
Mailing Address - Country:US
Mailing Address - Phone:434-964-9500
Mailing Address - Fax:434-964-9501
Practice Address - Street 1:215 WAYLES LN
Practice Address - Street 2:SUITE 150
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-4631
Practice Address - Country:US
Practice Address - Phone:434-964-9500
Practice Address - Fax:434-964-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237413207N00000X, 207ND0900X, 207NI0002X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Not Answered207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Not Answered207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Single Specialty
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
178139OtherBLUE CROSS AND BLUE SHIEL
178139OtherBLUE CROSS AND BLUE SHIEL
C09506Medicare ID - Type Unspecified