Organization
INTEGRATED DERMATOLOGY OF FAIRFAX, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY D. QUEEN (AUTHORIZED OFFICIAL)
(561) 314-2000
Entity
Organization
Contact information
Practice address
10680 MAIN ST STE 200, FAIRFAX, VA 22030-3810
(703) 352-2620
Mailing address
4700 EXCHANGE CT STE 110, BOCA RATON, FL 33431-4450
(561) 314-2000
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
12/16/2014
Last updated
02/21/2024
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