Provider Demographics
NPI:1699972406
Name:DERMATOLOGY CENTER OF LOUDOUN, PLC
Entity type:Organization
Organization Name:DERMATOLOGY CENTER OF LOUDOUN, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-723-9751
Mailing Address - Street 1:19455 DEERFIELD AVE
Mailing Address - Street 2:SUITE 311
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8100
Mailing Address - Country:US
Mailing Address - Phone:703-723-9751
Mailing Address - Fax:703-723-9752
Practice Address - Street 1:19455 DEERFIELD AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-8100
Practice Address - Country:US
Practice Address - Phone:703-723-9751
Practice Address - Fax:703-723-9752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty