Organization
COASTAL DERMATOLOGY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIMBERLY DIANE INGRAM SODERBERG I M.D. (PRESIDENT)
(757) 368-7546
Entity
Organization
Contact information
Practice address
3176 HOLLAND RD., 103, VIRGINIA BEACH, VA 23453
(757) 368-7546
Mailing address
3176 HOLLAND RD., 103, VIRGINIA BEACH, VA 23453
(757) 368-7546
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
0101241129
VA
Other
Enumeration date
04/14/2010
Last updated
04/14/2010
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