Provider Demographics
NPI:1215444377
Name:BARCROFT DERMATOLOGY, LLC
Entity type:Organization
Organization Name:BARCROFT DERMATOLOGY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAI
Authorized Official - Middle Name:HOANG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-892-3636
Mailing Address - Street 1:727 MCKINLEY ST NE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-3405
Mailing Address - Country:US
Mailing Address - Phone:703-281-3626
Mailing Address - Fax:703-281-3615
Practice Address - Street 1:939 S WAKEFIELD ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-3084
Practice Address - Country:US
Practice Address - Phone:703-892-3636
Practice Address - Fax:703-892-3626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244058261Q00000X
261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101244058OtherVA LICENSE
CA00A948510OtherMEDICAID
CAA94851OtherCA LICENSE
CA00A948510Medicaid
CAA94851OtherCA LICENSE