NPIMap

Organization Active NPI

Petersburg Dermatology, PC

  • Medical Specialty Clinic/Center
  • Petersburg, VA
National Provider Identifier
1740435650
Registry record updated Nov 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
0101052210 Issued in VA
Legal business name
PETERSBURG DERMATOLOGY, PC
Practice address
3277 S Crater Rd
Petersburg, VA 23805-9285
Phone
(804) 861-5555
Fax
(804) 861-5500
NPI assigned
Nov 19, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2008

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

Authorized official

Name
Dr. Erick Jean Freihofer, MD
Title
President
Phone
(804) 861-5555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X 0101052210 VA Primary

Addresses

Primary practice location

3277 S Crater Rd
Petersburg, VA 23805-9285

Mailing address

3277 S Crater Rd
Petersburg, VA 23805-9285
Phone (804) 861-5555

Other identifiers 1

IdentifierTypeStateIssuer
005900972MedicaidVA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1227052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227052800000",
    "number": "1740435650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3277 S CRATER RD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059285",
            "telephone_number": "804-861-5555",
            "fax_number": "804-861-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3277 S CRATER RD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059285",
            "telephone_number": "804-861-5555",
            "fax_number": "804-861-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSBURG DERMATOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-19",
        "last_updated": "2008-11-19",
        "status": "A",
        "authorized_official_last_name": "FREIHOFER",
        "authorized_official_first_name": "ERICK",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "804-861-5555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "VA",
            "license": "0101052210",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005900972",
            "state": "VA"
        }
    ],
    "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 Nov 19, 2008; 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.