NPIMap

Organization Active NPI

Warrenton Dermatology PC

Doing business as Warrenton Dermatology & Skin Therapy Center

  • Dermatology Physician
  • Warrenton, VA
National Provider Identifier
1396778205
Registry record updated Sep 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
WARRENTON DERMATOLOGY PC
Doing business as
Warrenton Dermatology & Skin Therapy Center
Practice address
28 Blackwell Park LN
Suite 302
Warrenton, VA 20186-2685
Phone
(540) 341-1900
Fax
(540) 341-0940
NPI assigned
Jul 7, 2006
Last updated
Sep 15, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2010

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

Authorized official

Name
Juan-Carlos Caballero, MDNPI 1801068937
Title
Owner/Authorized Official
Phone
(540) 341-1900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 0101051160 VA
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

28 Blackwell Park LN
Suite 302
Warrenton, VA 20186-2685

Mailing address

28 Blackwell Park LN
Suite 302
Warrenton, VA 20186-2685
Phone (540) 341-1900

Other names 1

  • Warrenton Dermatology & Skin Therapy Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041203000972 VA Part B Supplier - Clinic/Group Practice 3476519166 Receives reassigned benefits from 9 practitioners
Practice locations: Warrenton, VA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D0915818Warrenton Dermatology PC28 Blackwell Park Lane Suite 302, Warrenton, VA 20186Provider-performed microscopyMar 8, 2027
49D2245294Warrenton Dermatology & Skin Therapy Center28 Blackwell Park Lane Suite 102, Warrenton, VA 20186ComplianceNov 8, 2026

National Provider Directory

National Provider Directory

Locations

28 Blackwell Park Ln
Ste 102
Warrenton, VA 20186

28 Blackwell Park Ln
Ste 302
Warrenton, VA 20186
Phone (540) 341-1900

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284508800000",
    "number": "1396778205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 BLACKWELL PARK LN",
            "address_2": "SUITE 302",
            "city": "WARRENTON",
            "state": "VA",
            "postal_code": "201862685",
            "telephone_number": "540-341-1900",
            "fax_number": "540-341-0940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 BLACKWELL PARK LN",
            "address_2": "SUITE 302",
            "city": "WARRENTON",
            "state": "VA",
            "postal_code": "201862685",
            "telephone_number": "540-341-1900",
            "fax_number": "540-341-0940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WARRENTON DERMATOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2010-09-15",
        "status": "A",
        "authorized_official_last_name": "CABALLERO",
        "authorized_official_first_name": "JUAN-CARLOS",
        "authorized_official_title_or_position": "OWNER/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "540-341-1900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "VA",
            "license": "0101051160",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Warrenton Dermatology & Skin Therapy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Warrenton, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.