Prince William Dermatology, P.C.

Primary specialty

SpecialistTaxonomy code 174400000X

License

0101234235 Issued in VA

Legal business name

PRINCE WILLIAM DERMATOLOGY, P.C.

Practice address

7051 Heathcote Village Way
Suite 210
Gainesville, VA 20155

Phone

(571) 261-1234

Fax

(571) 261-2235

NPI assigned

Nov 9, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Cuong T. Ha, MDNPI 1962499061

Title

President

Phone

(571) 261-1234

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

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

CLIA laboratory certificates

Locations

Interoperability endpoints

• Direct secure messaging: ctha@directaddress.net

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cuong T. Ha, M.D.

  • Specialist
  • Gainesville, VA
  • NPI 1962499061
  Medicare reassignment NPD Authorized official
• Alexi Hildreth, PA-C

  • Physician Assistant
  • Gainesville, VA
  • NPI 1164396677
  NPD
• Meghan Morrell Neil, PA-C

  • Medical Physician Assistant
  • Gainesville, VA
  • NPI 1245098912
  NPD
• Sara Azer

  • Student in an Organized Health Care Education/Training Program
  • Gainesville, VA
  • NPI 1528878113
  NPD (past)
• Stephanie Petruzzo

  • Physician Assistant
  • Leesburg, VA
  • NPI 1093370348
  NPD (past)

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

{
    "created_epoch": "1194566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588118400000",
    "number": "1508046293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7051 HEATHCOTE VILLAGE WAY",
            "address_2": "SUITE 210",
            "city": "GAINESVILLE",
            "state": "VA",
            "postal_code": "20155",
            "telephone_number": "571-261-1234",
            "fax_number": "571-261-2235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7051 HEATHCOTE VILLAGE WAY",
            "address_2": "SUITE 210",
            "city": "GAINESVILLE",
            "state": "VA",
            "postal_code": "20155",
            "telephone_number": "571-261-1234",
            "fax_number": "571-261-2235"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7500 Iron Bar Ln",
            "address_2": "Suite 215",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "VA",
            "postal_code": "201553603",
            "country_code": "US",
            "telephone_number": "571-261-1234",
            "fax_number": "571-261-2235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRINCE WILLIAM DERMATOLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-09",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "status": "A",
        "authorized_official_last_name": "HA",
        "authorized_official_first_name": "CUONG",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "571-261-1234",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "VA",
            "license": "0101234235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ctha@directaddress.net",
            "affiliation": "N",
            "endpointDescription": "Direct messaging address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "7051 Heathcote Village Way",
            "address_2": "Suite 210",
            "city": "Gainesville",
            "state": "VA",
            "country_code": "US",
            "postal_code": "20155",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Anne Powell, FNP
• Powerback Rehabilitation LLC
• Premier Medical Transport LLC
• Prime Physical Therapy LLC
• Prince William Dental LLC
• Prince William H&R Ops Limited Partnership
• Prince William OBGYN Associates, LTD
• Pristine Healthcare Services, LLC
• Stephane Provencher, D.C.
• PT Solutions LLC

• Specialist in Gainesville, VA
• Providers in Gainesville, VA by specialty
• Specialist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2020; 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.