Provider Demographics
NPI:1316654221
Name:VICTORIA DERMATOLOGY, PA
Entity type:Organization
Organization Name:VICTORIA DERMATOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-836-4690
Mailing Address - Street 1:115 MEDICAL DR STE 202
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3106
Mailing Address - Country:US
Mailing Address - Phone:281-836-4690
Mailing Address - Fax:409-729-2449
Practice Address - Street 1:115 MEDICAL DR STE 202
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3106
Practice Address - Country:US
Practice Address - Phone:281-836-4690
Practice Address - Fax:409-729-2449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty