Provider Demographics
NPI:1326121435
Name:DERMATOLOGIC SURGERY CENTER OF WASHINGTON, LLC
Entity Type:Organization
Organization Name:DERMATOLOGIC SURGERY CENTER OF WASHINGTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF THE PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:MARAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:SKELSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-652-8081
Mailing Address - Street 1:5530 WISCONSIN AVE
Mailing Address - Street 2:SUITE# 820
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4401
Mailing Address - Country:US
Mailing Address - Phone:301-652-8081
Mailing Address - Fax:301-652-8627
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE# 820
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4401
Practice Address - Country:US
Practice Address - Phone:301-652-8081
Practice Address - Fax:301-652-8627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051027174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG06289Medicare UPIN