Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 0101054255 | VA |
N | 207NS0135X | Procedural Dermatology | 0101054255 | VA |
NPI | 1407817539 |
---|---|
Provider Name | Deborah W Lockman |
First Address | Charlottesville, VA 22901 |
Second Address | Charlottesville, VA 22901-1491 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 28/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005900344 | (05) | VA |
005900344 | VIRGINIA PREMIER (01) | VA |
070015380 | MEDICARE RAILROAD (01) | VA |
09102900001 | SOUTHERN HEALTH (01) | VA |
140450 | ANTHEM BC/BS (01) | VA |
700021771 | CIGNA (01) | VA |
G30615 | (02) | VA |