Beckley Dermatology Inc.
Organization Active NPI Dermatology Physician · Logan, WV
NPI 1740752880 · NPPES record last updated Dec 31, 2018
Key facts
- NPI
- 1740752880
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- BECKLEY DERMATOLOGY INC.
- Practice address
- 300 Prosperity LN Ste 207
Logan, WV 25601-3743 - Phone
- (304) 752-8202
- Fax
- (304) 752-0050
- NPI assigned
- Dec 31, 2018
- Organization subpart
- Yes
- Parent organization (as reported)
- BECKLEY DERMATOLOGY INC
Authorized official
- Name
- Nelson E. Velazquez, DO
- Title
- Owner
- Phone
- (304) 252-2673
Corporate family (same tax ID) 6
Practitioners 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 51D2042758 | Dermatology Associates & Surgery Center | Compliance | Mar 6, 2027 |
National Provider Directory
- Tax ID family
- Beckley Dermatology Inc
- Part of
- Beckley Dermatology Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | Yes | ||
| MOHS-Micrographic Surgery Physician |
207ND0101X | |||
| Dermatopathology Physician |
207ND0900X |
Addresses
Primary practice location
300 Prosperity LN Ste 207
Logan, WV 25601-3743
Mailing address
136 Linden Dr Ste 104
Winchester, VA 22601-6900
Phone (540) 678-3588
Other names
- Dermatology Associates & Surgery Center
Other providers in Logan, WV
- Debra Sue Barber
- Bradley Barnett
- Katelyn Elizabeth Barnhart
- Keirra Barrett
- Conda Bates
- Amanda Lynn Belcher
- Larry Lee Belcher
- Skylar Belcher
- Brooke Bell
- Kelly Bennett Adkins
All providers in Logan, WV · Dermatology Physician in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 31, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.