Organization
MID ATLANTIC DERMATOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROSE ANN WALLER (BILLING MANAGER)
(757) 547-9830
Entity
Organization
Contact information
Practice address
109 WIMBLEDON SQ, SUITE E, CHESAPEAKE, VA 23320-4945
(757) 547-9830
(757) 548-0721
Mailing address
109 WIMBLEDON SQ, SUITE E, CHESAPEAKE, VA 23320-4945
(757) 547-9830
(757) 548-0721
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
09/28/2006
Last updated
07/09/2008
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