Dockside Dermatology LLC
Dermatology in Millersville, MD. Organization (NPI-2).
NPI number1194479972
StatusActive
Last updated in NPPESMar 26, 2023
Details
- NPI
- 1194479972
- Entity type
- Organization (NPI-2)
- Legal business name
- Dockside Dermatology LLC
- Organization subpart
- No
- Enumeration date
- Feb 9, 2022
- Certification date
- Dec 6, 2022
- Last updated
- Mar 26, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207N00000X | Dermatology | – | – | Yes |
| 207NS0135X | Dermatology, Procedural Dermatology | – | – | |
| 261Q00000X | Clinic/Center | – | – | |
| 207ND0101X | Dermatology, MOHS-Micrographic Surgery | – | – | |
| 207NP0225X | Dermatology, Pediatric Dermatology | – | – |
Practice location
8601 Veterans Hwy Ste 201Millersville, MD 21108-1566
Phone 410-934-5400 · Fax 410-934-0141
Mailing address
8601 Veterans Hwy Ste 201Millersville, MD 21108-1566
Phone 410-934-5400 · Fax 410-934-0141
Authorized official
Lesley Sutherland
Owner
4105334200
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