Provider Demographics
NPI:1649271354
Name:DERM ASSOCIATES LLC
Entity type:Organization
Organization Name:DERM ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOCKSHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-681-7000
Mailing Address - Street 1:10313 GEORGIA AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5006
Mailing Address - Country:US
Mailing Address - Phone:301-681-7000
Mailing Address - Fax:301-681-1040
Practice Address - Street 1:10313 GEORGIA AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5006
Practice Address - Country:US
Practice Address - Phone:301-681-7000
Practice Address - Fax:301-681-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0016370207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD913261900Medicaid
DCW8449Medicare UPIN
MD913261900Medicaid