Provider Demographics
NPI:1023484219
Name:SHENANDOAH DERMATOLOGY, P.C.
Entity type:Organization
Organization Name:SHENANDOAH DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-885-4500
Mailing Address - Street 1:1600 N COALTER ST
Mailing Address - Street 2:SUITE 19
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-2551
Mailing Address - Country:US
Mailing Address - Phone:540-885-4500
Mailing Address - Fax:540-885-4600
Practice Address - Street 1:1600 N COALTER ST
Practice Address - Street 2:SUITE 19
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-2551
Practice Address - Country:US
Practice Address - Phone:540-885-4500
Practice Address - Fax:540-885-4600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101228437174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty