Organization
BLUE RIDGE DERMATOLOGY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOMITA LAWRENCE (PRACTICE MANAGER)
(540) 949-5470
Entity
Organization
Contact information
Practice address
1151 13TH ST, WAYNESBORO, VA 22980-4432
(540) 949-6934
(540) 932-7118
Mailing address
1151 13TH ST, WAYNESBORO, VA 22980-4432
(540) 949-6934
(540) 932-7118
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101028429
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
099634
ANTHEM BC/BS
VA
01
—
111868
ANTHEM BC/BS
VA
Enumeration date
06/11/2006
Last updated
08/10/2015
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