NPIMap

Organization Active NPI

Paladin Dermatology LLC

  • Nurse Practitioner
  • Petersburg, VA
National Provider Identifier
1225417082
Registry record updated Oct 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
0024164803 Issued in VA
Legal business name
PALADIN DERMATOLOGY LLC
Practice address
44 A& B Medical Park Blvd
Petersburg, VA 23805
Phone
(804) 648-4802
NPI assigned
May 27, 2015
Last updated
Oct 27, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joe Hernandez
Title
Managing Official
Phone
(804) 648-4802

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 0024164803 VA Primary

Addresses

Primary practice location

44 A& B Medical Park Blvd
Petersburg, VA 23805

Mailing address

1801 Libbie Ave Ste 204
Richmond, VA 23226-1836

National Provider Directory

National Provider Directory

Locations

7300 Ashlake Pkwy
Ste 100
Chesterfield, VA 23832
Phone (804) 256-8282

360 Browns Hill Ct
Ste B
Midlothian, VA 23114
Phone (804) 991-6542

1801 Libbie Ave
Ste 201
Richmond, VA 23226
Phone (804) 324-4511

1801 Libbie Ave
Ste 204
Richmond, VA 23226

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 34

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1432684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445904000000",
    "number": "1225417082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 LIBBIE AVE STE 204",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232261836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 A& B MEDICAL PARK BLVD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "23805",
            "telephone_number": "804-648-4802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALADIN DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-27",
        "last_updated": "2015-10-27",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "JOE",
        "authorized_official_title_or_position": "MANAGING OFFICIAL",
        "authorized_official_telephone_number": "804-648-4802"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VA",
            "license": "0024164803",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.