Prince William Dermatology, P.C.
Specialist in Gainesville, VA. Organization (NPI-2).
NPI number1508046293
StatusActive
Last updated in NPPESApr 29, 2020
Details
- NPI
- 1508046293
- Entity type
- Organization (NPI-2)
- Legal business name
- Prince William Dermatology, P.C.
- Organization subpart
- No
- Enumeration date
- Nov 9, 2007
- Certification date
- Apr 29, 2020
- Last updated
- Apr 29, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART B SUPPLIER - CLINIC/GROUP PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | 0101234235 | VA | Yes |
Practice location
7051 Heathcote Village WaySuite 210
Gainesville, VA 20155
Phone 571-261-1234 · Fax 571-261-2235
Mailing address
7051 Heathcote Village WaySuite 210
Gainesville, VA 20155
Phone 571-261-1234 · Fax 571-261-2235
Other practice locations
Authorized official
Cuong T. Ha
President
5712611234
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