Organization
DERMATOLOGY CONSULTANTS OF GLOUCESTER P L L C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID W. MUFFELMAN M.D. (PRESIDENT)
(804) 693-6527
Entity
Organization
Contact information
Practice address
6790 WOOD RIDGE DRIVE, GLOUCESTER, VA 23061
(804) 693-6527
(804) 693-6615
Mailing address
PO BOX 693, GLOUCESTER, VA 23061
(804) 693-6527
(804) 693-6615
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101026776
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141598
ANTHEM BCBS GROUP NUMBER
VA
01
—
CJ9476
RAILROAD MEDICARE
VA
Enumeration date
05/04/2007
Last updated
06/07/2011
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