Provider Demographics
NPI:1982760963
Name:WASHINGTON DERMATOLOGY CONSULTANTS, PLC
Entity type:Organization
Organization Name:WASHINGTON DERMATOLOGY CONSULTANTS, PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF DERMATOLOGIC SURGERY
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-431-6175
Mailing Address - Street 1:611 S CARLIN SPRINGS RD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1064
Mailing Address - Country:US
Mailing Address - Phone:571-431-6175
Mailing Address - Fax:571-431-6179
Practice Address - Street 1:611 S CARLIN SPRINGS RD
Practice Address - Street 2:SUITE 406
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1064
Practice Address - Country:US
Practice Address - Phone:571-431-6175
Practice Address - Fax:571-431-6179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237321207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty