Provider Demographics
NPI:1699893388
Name:AVENUES DERMATOLOGY PLLC
Entity type:Organization
Organization Name:AVENUES DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:S
Authorized Official - Last Name:PHIEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-288-4410
Mailing Address - Street 1:420 LIBBIE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2616
Mailing Address - Country:US
Mailing Address - Phone:804-288-4410
Mailing Address - Fax:804-288-4458
Practice Address - Street 1:420 LIBBIE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2616
Practice Address - Country:US
Practice Address - Phone:804-288-4410
Practice Address - Fax:804-288-4458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101059025305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1229850OtherHMO
VA7229207OtherNON-HMO
VA187989OtherANTHEM
VA7229207OtherNON-HMO
VAH33179Medicare UPIN
VADE6352Medicare PIN