Virginia Dermatology and Skin Surgery Center

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

0101249163 Issued in VA

Legal business name

VIRGINIA DERMATOLOGY AND SKIN SURGERY CENTER

Practice address

1985 Jefferson Davis Hwy
Fredericksburg, VA 22401-5298

Phone

(540) 373-6647

Fax

(540) 479-1656

NPI assigned

Apr 25, 2011

Last updated

Aug 25, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mark P. Eid, MDNPI 1861695181

Title

Medical Director

Phone

(540) 373-6647

Specialties & licenses 2

Addresses

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Virginia Dermatology & Skin Surgery Center

  • Clinical Informatics (Pathology) Physician
  • Fredericksburg, VA
  • NPI 1437644341
  NPPES parent name

Practitioners 5

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.

• Mark P. Eid, MD

  • MOHS-Micrographic Surgery Physician
  • Fredericksburg, VA
  • NPI 1861695181
  Authorized official Same address or phone
• Abrahem Kazemi, MD

  • Dermatology Physician
  • Centreville, VA
  • NPI 1700383585
  NPD (past)
• Christian Richard Millett, M.D.

  • Dermatology Physician
  • Arlington, VA
  • NPI 1902138761
  NPD (past)
• Adeel Ahmad, M.D

  • Dermatopathology Physician
  • Beckley, WV
  • NPI 1578717997

  Mohs-Micrographic Surgery

  NPD (past)
• Michelle Arlene Demattia, PA-C

  • Medical Physician Assistant
  • Annapolis, MD
  • NPI 1316056575
  NPD (past)

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

{
    "created_epoch": "1303689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629849600000",
    "number": "1598056582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1985 JEFFERSON DAVIS HWY",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224016233",
            "telephone_number": "540-373-6647",
            "fax_number": "540-479-1656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1985 JEFFERSON DAVIS HWY",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224015298",
            "telephone_number": "540-373-6647",
            "fax_number": "540-479-1656"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13875 Hedgewood Dr",
            "address_purpose": "LOCATION",
            "city": "Woodbridge",
            "state": "VA",
            "postal_code": "221937930",
            "country_code": "US",
            "telephone_number": "540-373-6647",
            "fax_number": "540-479-1656",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "385 Garrisonville Rd Ste 205",
            "address_purpose": "LOCATION",
            "city": "Stafford",
            "state": "VA",
            "postal_code": "225541599",
            "country_code": "US",
            "telephone_number": "540-373-6647",
            "fax_number": "540-479-1656",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2616 Sherwood Hall Ln Ste 306",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "VA",
            "postal_code": "223063154",
            "country_code": "US",
            "telephone_number": "540-373-6647",
            "fax_number": "540-479-1656",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1982 Opitz Blvd",
            "address_purpose": "LOCATION",
            "city": "Woodbridge",
            "state": "VA",
            "postal_code": "221913304",
            "country_code": "US",
            "telephone_number": "540-373-6647",
            "fax_number": "540-479-1656",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "492 Blackwell Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Warrenton",
            "state": "VA",
            "postal_code": "201862682",
            "country_code": "US",
            "telephone_number": "540-930-0607",
            "fax_number": "540-930-0608",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6101 Redwood Square Ctr Ste 117",
            "address_purpose": "LOCATION",
            "city": "Centreville",
            "state": "VA",
            "postal_code": "201214266",
            "country_code": "US",
            "telephone_number": "571-400-2110",
            "fax_number": "571-400-2151",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VIRGINIA DERMATOLOGY AND SKIN SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-25",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A",
        "authorized_official_last_name": "EID",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "540-373-6647",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "VA",
            "license": "0101249163",
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Virginia CVS Pharmacy, L.L.C. (CVS Pharmacy #01564)
• Virginia CVS Pharmacy, LLC (Cvs Pharmacy #11179)
• Virginia Dental & Anesthesia Associates
• Virginia Dept. of Public Health
• Virginia Dermatology & Skin Surgery Center
• Virginia Healthcare Services of Fredericksburg
• Virginia Integrative Psychiatry, PC
• Virginia Interventional Spine Associates PC
• Virginia Oncology Care,PC
• Virginia Oncology Care,PC

• MOHS-Micrographic Surgery Physician in Fredericksburg, VA
• Providers in Fredericksburg, VA by specialty
• MOHS-Micrographic Surgery Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2021; 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.