Provider Demographics
NPI:1649230806
Name:COLUMBIA DERMATOLOGY CENTER
Entity Type:Organization
Organization Name:COLUMBIA DERMATOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-772-0707
Mailing Address - Street 1:10910 LITTLE PATUXENT PKWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3078
Mailing Address - Country:US
Mailing Address - Phone:410-772-0707
Mailing Address - Fax:
Practice Address - Street 1:10910 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3078
Practice Address - Country:US
Practice Address - Phone:410-772-0707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
483MMedicare ID - Type Unspecified