DR. WILMER KENNETH BLAYLOCK (NPI# 1417982778) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417982778 |
| Entity Type | Individual |
| Full Name | DR. WILMER KENNETH BLAYLOCK |
| Credential | M.D. |
| Practice Address |
1250 E Marshall St Dermatology - Richmond VA 23298-5051 |
| Mailing Address |
Po Box 91734 Richmond VA 23291-1734 |
| Practice Telephone | 8048289361 |
| Practice Fax Number | 8048289596 |
| Mailing Telephone | 8043586100 |
| Mailing Fax Number | 8043427619 |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 0101013569 | VA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 5911761 | 05 |
| Street Address |
1250 E MARSHALL ST DERMATOLOGY - |
| City | RICHMOND |
| State | VA |
| Zip Code | 23298-5051 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265436158 | Elizabeth A Huntoon | Physical Medicine & Rehabilitation | 1250 E Marshall St, Physical Medicine and Rehab, Richmond, VA 23298-5051 | 2005-06-08 |
| 1700485943 | Jayme Holmes Kunkel | Nurse Practitioner | 1250 E Marshall St, Richmond, VA 23298-5023 | 2020-10-20 |
| 1508463068 | Benjamin Brickman Holt | Nurse Practitioner | 1250 E Marshall St, Richmond, VA 23298-5023 | 2020-10-07 |
| 1780298620 | Tara Lynne Taylor | Nurse Practitioner | 1250 E Marshall St, Richmond, VA 23298-5023 | 2020-09-08 |
| 1770197956 | Imane Chedid | Emergency Medicine | 1250 E Marshall St, Richmond, VA 23298-5023 | 2020-09-03 |
| 1659982338 | Randi Thompson | Nurse Practitioner | 1250 E Marshall St, Richmond, VA 23298-5023 | 2020-08-14 |
| 1619585684 | Chelsea Elise Snead | Nurse Practitioner | 1250 E Marshall St, Richmond, VA 23298-5023 | 2020-07-16 |
| 1285258095 | Trevor Harrison Nordin | Student in an Organized Health Care Education/Training Program | 1250 E Marshall St, Richmond, VA 23298-5051 | 2020-06-08 |
| 1912521972 | Ashton Jordan Engdahl | Student in an Organized Health Care Education/Training Program | 1250 E Marshall St, Richmond, VA 23298-5051 | 2020-06-04 |
| 1538783048 | Ann Forrest | Student in an Organized Health Care Education/Training Program | 1250 E Marshall St, Richmond, VA 23298-5051 | 2020-05-31 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730703604 | Russell Wayne Dowell | Student in an Organized Health Care Education/Training Program | Vcuhs Dept of Em Residency/fellowship, 1250 E. Marshall Street, Richmond, VA 23298 | 2020-06-05 |
| 1215551262 | Anna Leigh Cline | Student in an Organized Health Care Education/Training Program | Vcuhs Department of Emergency Medicine, 980401, 1250 E Marshall Street, Richmond, VA 23298 | 2020-06-05 |
| 1598389629 | Annabel Eujung Baek | Student in an Organized Health Care Education/Training Program | Vcuhs Dept of Plastic Surgery Residency, 980154, 1250 E. Marshall Street, Richmond, VA 23298 | 2020-06-04 |
| 1235752957 | Valerie Tammy Tran | Student in an Organized Health Care Education/Training Program | Internal Medicine Residency, 980509, 1250 E Marshall St, Richmond, VA 23298 | 2020-05-28 |
| 1386267193 | Michael Terribile | Student in an Organized Health Care Education/Training Program | Vcuhs Department of Pediatrics Residency, 980163, Richmond, VA 23298 | 2020-05-27 |
| 1417585449 | Ryan Louis Naum | Student in an Organized Health Care Education/Training Program | Vcuhs Dept. of Neurology Residency, #980599, 1250 E. Marshall Street, Richmond, VA 23298 | 2020-03-27 |
| 1477102531 | Shanon Fitzpatrick Beam | Nurse Practitioner | Vcu Medical Center, 1250 East Marshall Street, Richmond, VA 23298 | 2019-09-10 |
| 1922666924 | Sumerth Kumar Pathak | Student in an Organized Health Care Education/Training Program | Vcuhs Dept of Psychiatry, 980710, 1250 E. Marshall Street, Richmond, VA 23298 | 2019-06-04 |
| 1467010595 | Christopher Bednarz | Student in an Organized Health Care Education/Training Program | Vcuhs Dept of Surgery Residency, 980118, 1250 E. Marshall Street, Richmond, VA 23298 | 2019-06-04 |
| 1629636782 | Nicholet Mitchell | Student in an Organized Health Care Education/Training Program | Vcuhs Dept of Em Residency/fellowship, 980401, 1250 E. Marshall Street, Richmond, VA 23298 | 2019-06-04 |
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| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588210330 | Brandi M Horner | Dermatology | 7650 E Parham Road, Ste 110, Richmond, VA 23294-4367 | 2019-08-16 |
| 1811211592 | Adam A Martin | Dermatology | 6946 Forest Ave Ste 200, Richmond, VA 23230-1701 | 2010-03-24 |
| 1114153285 | Brigitte Ullrich | Dermatology | 8715 Higginbotham Pl, Richmond, VA 23229-7935 | 2009-06-03 |
| 1972773745 | Laser & Skin Surgery Center of Richmond PC | Dermatology | 7001 Forest Ave., Suite 301, Richmond, VA 23230-1724 | 2008-03-07 |
| 1366631038 | Shelley K. Hoover, M.d., PC | Dermatology | 8600 Staples Mill Rd, Richmond, VA 23228-2719 | 2007-10-18 |
| 1891997433 | Jon Mark Igelman | Dermatology | 3113 Devon Drive, Richmond, IN 47374-9750 | 2007-06-05 |
| 1316907371 | Hazel J Vernon | Dermatology | 7001 Forest Ave Ste 300, Richmond, VA 23230-1726 | 2006-03-24 |
| 1346225802 | Christopher Robert Gorman | Dermatology | 420 Libbie Avenue, Richmond, VA 23226 | 2005-12-07 |
| 1215921390 | Dwight D. Smith | Dermatology | 180 Glenwood Dr, Richmond, IN 47374-3565 | 2005-09-06 |
| 1669466819 | Christopher Timberlake Aleman | Dermatology | 10710 Midlothian Tpke Ste 401, Richmond, VA 23235-4723 | 2005-09-02 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.