Amalie S Derdeyn, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

0101241359 Issued in VA

Practice address

3350 Berkmar Drive
Charlottesville, VA 22901

Phone

(434) 923-4651

Fax

(434) 964-3636

NPI assigned

Mar 20, 2007

Last updated

Apr 14, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428969600000",
    "number": "1871618504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3350 BERKMAR DRIVE",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "22901",
            "telephone_number": "434-923-4651",
            "fax_number": "434-964-3636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3350 BERKMAR DRIVE",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "22901",
            "telephone_number": "434-923-4651",
            "fax_number": "434-964-3636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERDEYN",
        "first_name": "AMALIE",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-20",
        "last_updated": "2015-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "VA",
            "license": "0101241359",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH PROVIDER #",
            "identifier": "11718431",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John M. Dent, M.D.
• Dental Professionals of Virginia, P.C. (Blue Ridge Family Dentistry)
• Dental Professionals of Virginia, P.C. (Barracks Road Dental Care)
• Kasey Leigh Depriest, CPRS
• Alison C. Derbes, M.D.
• Colin P Derdeyn, MD
• Dermatologic Surgery of Central Virginia PLC
• Dermatology PLC
• Rachel Elizabeth Derrickson, BCABA
• Shivali Sanjay Desai

• Dermatology Physician in Charlottesville, VA
• Providers in Charlottesville, VA by specialty
• Dermatology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2015; 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.