Individual
DR. AMALIE S DERDEYN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3350 BERKMAR DRIVE, CHARLOTTESVILLE, VA 22901
(434) 923-4651
(434) 964-3636
Mailing address
3350 BERKMAR DRIVE, CHARLOTTESVILLE, VA 22901
(434) 923-4651
(434) 964-3636
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
0101241359
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11718431
CAQH PROVIDER #
VA
Enumeration date
03/20/2007
Last updated
04/14/2015
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