Basic Information
| Provider Information | |||||||||
| NPI: | 1962890186 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DERMATOLOGY & ADVANCED SKIN CARE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6021 UNIVERSITY BLVD | ||||||||
| Address2: | STE 390 | ||||||||
| City: | ELLICOTT CITY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210436077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102030607 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6021 UNIVERSITY BLVD | ||||||||
| Address2: | STE 390 | ||||||||
| City: | ELLICOTT CITY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210436077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102030607 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2014 | ||||||||
| LastUpdateDate: | 12/23/2014 | ||||||||
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| AuthorizedOfficialLastName: | MASHBURN | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4102030607 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | H0077765 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.