Organization
CLINICAL DERMATOLOGY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MIKHAIL A PAVLOV (PRACTICE MANAGER)
(410) 371-6302
Entity
Organization
Contact information
Practice address
14500 AVION PKWY STE 100, CHANTILLY, VA 20151-1108
(703) 705-7000
(703) 763-7255
Mailing address
14500 AVION PKWY STE 100, CHANTILLY, VA 20151-1108
(703) 705-7000
(703) 763-7255
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1578682894
INDIVIDUAL NPI
—
Enumeration date
05/14/2020
Last updated
07/17/2020
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