Provider Demographics
NPI:1053598474
Name:ALLPHASES DERMATOLOGY LLC
Entity type:Organization
Organization Name:ALLPHASES DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:APPIAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-822-0222
Mailing Address - Street 1:6355 WALKER LN STE 311
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3258
Mailing Address - Country:US
Mailing Address - Phone:703-822-0222
Mailing Address - Fax:703-822-8222
Practice Address - Street 1:6355 WALKER LN STE 311
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3258
Practice Address - Country:US
Practice Address - Phone:703-822-0222
Practice Address - Fax:703-822-8222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231652207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01612Medicare PIN