Provider Demographics
NPI:1205900537
Name:DRS. FORD AND ROTHMAN COSMETIC AND CLINICAL DERMATOLOGY, LLC
Entity type:Organization
Organization Name:DRS. FORD AND ROTHMAN COSMETIC AND CLINICAL DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONI
Authorized Official - Middle Name:W
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-977-2070
Mailing Address - Street 1:6 MONTGOMERY VILLAGE AVE
Mailing Address - Street 2:SUITE 322
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3546
Mailing Address - Country:US
Mailing Address - Phone:301-977-2070
Mailing Address - Fax:301-330-9452
Practice Address - Street 1:6 MONTGOMERY VILLAGE AVE
Practice Address - Street 2:SUITE 322
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3546
Practice Address - Country:US
Practice Address - Phone:301-977-2070
Practice Address - Fax:301-330-9452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044738207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD720928Medicare UPIN