Organization
CAPITAL DERMATOLOGY LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE DAVID GLASSMAN M.D. (PRESIDENT)
(703) 370-0073
Entity
Organization
Contact information
Practice address
4660 KENMORE AVE STE 500, ALEXANDRIA, VA 22304-1300
(703) 370-0073
(703) 370-2002
Mailing address
4660 KENMORE AVE STE 500, ALEXANDRIA, VA 22304-1300
(703) 370-0073
(703) 370-2002
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0483568
AETNA HMO GROUP
—
01
—
111874
KAISER GROUP
—
01
—
5629309
AETNA PPO GROUP
—
Enumeration date
10/09/2006
Last updated
04/01/2011
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