MID ATLANTIC DERMATOLOGY
NPI 1073605333
Dermatology in Chesapeake, VA

Active since September 28, 2006
109 WIMBLEDON SQ, SUITE E, CHESAPEAKE, VA 23320(757) 547-9830(757) 548-0721 Get Directions Write a Review

NPPES record last updated: July 9, 2008. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Mid Atlantic Dermatology NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MID ATLANTIC DERMATOLOGY (NPI 1073605333) is a healthcare organization registered as a dermatology in Chesapeake, Virginia and active in the NPI registry since September 2006. The organization lists Rose Ann Waller, Billing Manager, as its authorized official.

NPPES Registry Identity

NPI1073605333
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameMID ATLANTIC DERMATOLOGY
Location Address109 WIMBLEDON SQ, SUITE EChesapeake, VA 23320-4945
Mailing Address109 Wimbledon Sq, Suite EChesapeake, VA 23320-4945 · (757) 547-9830 · Fax (757) 548-0721
Fax(757) 548-0721
Organization SubpartNo
Authorized OfficialRose Ann WallerBilling Manager · (757) 547-9830
Enumeration DateSeptember 28, 2006
Last NPPES UpdateJuly 9, 2008
✔ NPI 1073605333 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
109 WIMBLEDON SQ, Chesapeake, VA 23320

Other Identifiers 1

Medicare ID-Type UnspecifiedC06097VA · Group Number

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mid Atlantic Dermatology is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Mid Atlantic Dermatology, which bills Medicare for the services this clinician delivers.

Clinician (1)

Dermatology
NPI 1932105285
828 HEALTHY WAY SUITE 300
Virginia Beach, VA 23462
(757) 965-6165
✔ PECOS✔ Accepts Medicare7.8 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mid Atlantic Dermatology's NPI number?

The NPI number for Mid Atlantic Dermatology is 1073605333. It was assigned to this organization in the NPPES registry on September 28, 2006.

Where is Mid Atlantic Dermatology located?

Mid Atlantic Dermatology is located at 109 Wimbledon Sq Suite E, Chesapeake, VA 23320. The listed phone number is (757) 547-9830.

What is Mid Atlantic Dermatology's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Mid Atlantic Dermatology enrolled in Medicare?

Yes. Mid Atlantic Dermatology is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Mid Atlantic Dermatology?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Mid Atlantic Dermatology. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Mid Atlantic Dermatology was last updated on July 9, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.