Provider Demographics
NPI:1972773745
Name:LASER & SKIN SURGERY CENTER OF RICHMOND PC
Entity type:Organization
Organization Name:LASER & SKIN SURGERY CENTER OF RICHMOND PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GALEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-855-0372
Mailing Address - Street 1:7001 FOREST AVENUE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1724
Mailing Address - Country:US
Mailing Address - Phone:804-855-0372
Mailing Address - Fax:
Practice Address - Street 1:7001 FOREST AVE.
Practice Address - Street 2:SUITE 301
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1724
Practice Address - Country:US
Practice Address - Phone:804-855-0372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238054207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10505Medicare PIN