Provider Demographics
NPI:1215913314
Name:ROCKINGHAM DERMATOLOGY, P.C.
Entity type:Organization
Organization Name:ROCKINGHAM DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:ILENE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-442-8056
Mailing Address - Street 1:2061 EVELYN BYRD AVE STE C
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3442
Mailing Address - Country:US
Mailing Address - Phone:540-442-8056
Mailing Address - Fax:540-442-8022
Practice Address - Street 1:2061 EVELYN BYRD AVE STE C
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3442
Practice Address - Country:US
Practice Address - Phone:540-442-8056
Practice Address - Fax:540-442-8022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057474207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09536Medicare ID - Type UnspecifiedGROUP NUMBER
G70692Medicare UPIN