Provider Demographics
NPI:1427190982
Name:CECIL DERMATOLOGY LLC
Entity Type:Organization
Organization Name:CECIL DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-633-5840
Mailing Address - Street 1:304 NORTH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5570
Mailing Address - Country:US
Mailing Address - Phone:410-620-9722
Mailing Address - Fax:
Practice Address - Street 1:304 NORTH ST STE 3
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5570
Practice Address - Country:US
Practice Address - Phone:410-620-9722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053034208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDDC3411OtherMEDICARE RAILROAD
MDDC3411OtherMCR RAILROAD PIN
MDDC3411OtherMCR RAILROAD PIN
MD915MMedicare PIN