DERMATOLOGY & ADVANCED SKIN CARE NPI 1992738124

NPI Information

  • NPI: 1992738124
  • Provider Name: DERMATOLOGY & ADVANCED SKIN CARE
  • Classification: Specialist - 174400000X
  • Entity Type: Organization
  • CLIA Number: 21D0212684
  • Address: 6021 UNIVERSITY BLVD
    SUITE 390
    ELLICOTT CITY, MD
    ZIP 21043
  • Phone: (410) 203-0607

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NPI Details

DERMATOLOGY & ADVANCED SKIN CARE is a specialist in Ellicott City, MD. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. DERMATOLOGY & ADVANCED SKIN CARE NPI is 1992738124. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

6021 UNIVERSITY BLVD
SUITE 390
ELLICOTT CITY, MD
ZIP 21043-077
Phone: (410) 203-0607
Fax: (410) 203-0677

The provider's authorized official is Elisa Rusonis .
The authorized official title is Administrator and has the following contact phone number (410) 203-0607.

The CLIA number assigned to this NPI record is 21D0212684 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 7/9/2006 and was last updated on 7/1/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialistD0030058MARYLANDYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1553M860FOTHERMARYLANDMEDICARE PTAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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